MOVITA JUICE BAR OFFICIAL FRANCHISE APPLICATION

This Application is kept confidential. Neither party is bound in any way by submission of this Application. This Application must be submitted in full for further contact from Movita Juice Bar Franchise Corp. Attach additional documents/schedules, if necessary, to provide full disclosure.

(If "Married", please complete the Spouse's Information section below)

What is the highest level of education you have obtained?

I attest to the best of my ability that all of my Assets and Liabilities as of the date of this application include:

Pursuant to the Federal Fair Credit Reporting Act (FCRA), by signing this Application, I hereby authorize Movita Juice Bar Franchise Corporation and its designated agents and representatives to conduct a comprehensive review of my credit history through a consumer report to be generated for the purpose of application for a franchise from Movita Juice Bar Franchise Corporation. I understand that the scope of the consumer report may include, but is not limited to verification of Social Security Number; current and previous residences; employment history; references; credit history and reports; criminal history, including records from any criminal justice agency in any or all federal, state or county jurisdictions; motor vehicle records; and any other public records. I understand that, pursuant to the Federal Fair Credit Reporting Act, if any adverse action is to be taken based upon the consumer report, a copy of the report and a summary of the consumer's rights will be provided to me by Movita Juice Bar Franchise Corporation upon request.

If "Yes", please list the name(s) of the operator(s)/partner(s) who will acquire interest in the proposed franchise Note: All partners must submit a separate Application. 100% ownership must be disclosed and identified (Voting, Capital, and Profits Interest).

(List the names and addresses of three persons who have known you for at least five years)

(List the names and addresses of three persons who have known you for at least five years)

What do you expect from Movita Juice Bar as a franchisor?

What were the major hurdles working in the company listed above?

What is your long-term goal as a franchisee?

The following documents must be submitted in conjunction with this Application:

IN CONSIDERATION OF and as a condition of the Movita Juice Bar Franchise Corporation providing confidential information to the Applicant in addition to other valuable consideration, the receipt and sufficiency of which consideration is hereby acknowledged, by signing this Application, I agree to the following:

(a) In any position the Applicant may hold, as a result of the Applicant’s consideration for a Movita Juice Bar franchise, the Applicant will, or may, be making use of, disclosing, acquiring or adding information about certain matters that are confidential to AND exclusive property of Movita Juice Bar Franchise Corporation.

(b) Except as otherwise provided in this agreement, the Confidential Information will remain the exclusive property of Movita Juice Bar Franchise Corporation and will only be used by the Applicant for the Permitted Purpose

The information I have provided herein is accurate to the best of my knowledge. I understand that acceptance of this Application by Movita Juice Bar Franchise Corporation does not constitute that I will be granted the rights to open a Movita Juice Bar franchise and/or any particular market. I hereby authorize all credit rating agencies, former and current employers, and references named herein, to release to Movita Juice Bar Franchise Corporation all information (personal and financial) known to them about me. I fully understand and agree that if I misrepresent any information on this Application, it is grounds for termination at the sole discretion of Movita Juice Bar Franchise Corporation, including but not limited to any Franchise Agreement(s) that may be entered into between Movita Juice Bar Franchise Corporation and myself.

Please sign and date this form. By signing this form you warrant, represent and certify that the foregoing statements are true, complete and accurate as of the date and declare that you will immediately notify Movita Juice Bar Franchise Corporation of any change in the foregoing information. You understand that the foregoing representations will be relied upon by Movita Juice Bar Franchise Corporation in determining whether or not it will grant a franchise.

Applicant

SPOUSE