Franchisee Business Information Franchisee Information Form New Franchisee or Franchisee Change of Information Form Information - New or Change* New Franchisee Change in Current Franchise KEY CONTACT INFORMATIONName - Primary Contact #1* First Last Email - Person #1* Phone - Person #1Name - Person #2 First Last Email - Person #2 Phone - Person #2REGISTERED BUSINESS NAME(or name attempting to register)New Business NamePrevious Business NameBusiness is Registered? YES NO Business #Franchise Area (NEW)(use local MHA or geographic region)Franchise Area (PREVIOUS)(use local MHA or geographic region)CORPORATE EMAILRequested email address for club - @PlayFloorball.ca Example: David@PlayFloorball.ca#1 _________@playfloorball.ca#2 _________@playfloorball.ca#3 _________@playfloorball.caWEBSITE DOMAINExample: HalifaxFloorball.caNew Site URL:Previous or Existing Site URL:BUSINESS INFORMATIONBusiness Address (Physical/Mailing) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Business Phone NumberTo Be Included on Business Card? Yes No Business Mobile Phone NumberTo Be Included on Business Card? Yes No BANKING INFORMATIONBank Preferred: RBC. Numbers for the fields below will be on the bottom of your cheque.NEW Transit #PREVIOUS Transit #NEW BRANCH #Previous BRANCH #NEW Account #Previous Account #NEW BRANCH/Location NamePrevious BRANCH/Location NameFILE UPLOADSBio PictureLogoOther - Describe the file you are uploading:OTHERCOMMENTS OR ADDITIONAL INFORMATIONPlease use this section to provide any commentary or additional information that you feel is relevant to your submissions above.DETAILS:
