In submitting this completed form, it is understood you are under no obligation. If a review of this preliminary information indicates that you may have the qualifications to become a franchisee, Cybervision (M) Sdn. Bhd. will provide more information on the opportunities available for a qualified individual to become a COMPUTERTOTS / COMPUTER EXPLORERS® franchisee.

If you prefer, you may print this form and mail it to CYBERVISION SDN. BHD. 39-5, The Boulevard, Mid-Valley City, Lingkaran Syed Putra, 59200 Kuala Lumpur, Malaysia Or FAX us at 603-22012032



FRANCHISE APPLICATION FORM

Personal Information

Full Name : *
Street Address : *
City : *
State : *
Postal Code : *
Contact No :
Complete E-mail Address : *
Date of Birth : *
Marital Status : *
Spouse's Name :
Would you prefer to be contacted at home or at work to set up a telephone interview? *
How did you learn about COMPUTERTOTS® / COMPUTER EXPLORERS® franchise? *
Territories in which you are interested? *

Financial Information

Annual Household income :

Self : *
(spouse or other) :
Please indicate the amount of cash you have available to invest in a COMPUTERTOTS® / COMPUTER EXPLORERS® business : *
COMPUTERTOTS® / COMPUTER EXPLORERS® does not provide financing.
If you do not have the full amount needed to purchase the franchise, what are your plans for financing? *

Business Operation

When would you be able to start? *
Do you anticipate a partner? *
If yes, relationship to you :
Their role in business :
Why are you a good candidate for this opportunity? *

Employment summary and experience
Security Code
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Finally, click "Send Request", or "Reset Form" to start over.



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