Application for Additional Information

This form is not to be construed as an offer of a franchise, a commitment, or a binding agreement on either party. The filling out of this application does not obligate the applicant to purchase a franchise or the franchiser to sell a franchise. (* Mandatory Fields)

Forms such as these are always a bit standardized. Don’t hesitate to answer in a manner that best suits you (short, business-like, personal, detailed, with pictures, drawings, etc.)

* Username
* You are interested in applying for Madame or Nyciti Store
* Where did you first hear about or see a madame store?
* You are interested in opening a madame store in
* In which city?
* In which area/location?
Primary Application Information
* First Name Middle Name * Last Name
* Applying for
* Contact Details
* Mobile Number
* Address
* City
Postal Code
* Email Address (User Name)
Educational Qualification
Employment Experience and Information

* Self employed/Employed by (Enter company's name below)

* Posting * Company Name
Please provide a brief summary of your duties, responsibilities in current/last position
Have you ever owned your own business or franchise?
* Will you devote your full time to this business?
* Will you be the sole owner of this business?
* Have you ever applied for a madame franchise?
If YES, where and when?
Do you have franchisee rights to any other Company also?
If Yes Please mention name of the Company/Brand(s)
Investment Capability In Our Brands
Please attach your Site Images * Image 1
   Image 2
   Image 3
* Enter the code displayed in the image 6318295
Please Read Carefully

I understand that the submission of this application does not obligate me or madame© in any manner, nor does it imply that there is any legal or commercial relationship between myself and madame©. I further understand that madame© has the sole right to approve or disapprove the Application for any reason it may determine, and in the event that madame© rejects the Application, madame© shall have no liability or ongoing obligations toward me.

I certify that the information contained in this Application is accurate and complete.

I authorize madame©, or its agent, to investigate my background as it pertains to my qualifications and to verify any and all data submitted; to obtain a credit report and obtain any other information about my credit history as it seems necessary in order to evaluate my suitability as a potential madame© franchisee.