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Business Application and Net Worth Form

Please note that this is not a contract. We ask you to fill out this form in order to determine mutual compatibility and financial capability. As part of the screening process, we may obtain your credit information. Any information disclosed will remain confidential. The submission of this form does not obligate you in any way.

Date:
* Name :
Date of Birth :	(yyyy/mm/dd)
Marital Status :
Social Security Number :	- -
* Home Address :
* City :
* State :
* Zip :
Telephone :	H: B:
* Email Address :
Are you a citizen of the USA? Yes, No
If not, are you a US resident alien? Yes, No
If not, what is your visa status?
Have you ever been convicted of a felony? Yes, No
If yes, please state details:

Name :
Year Graduated :
Degree :
High School:
College :
Graduate or Professional School :

1.	Self Employed Employed By
Company Name :
No. Years :
Address :
City :
State :
Zip :
Type of Business:
Position:
Duties and Responsibilities :
Telephone :	May you be contacted at work? Yes No
2.	Self Employed Employed By
Company Name :
No. Years :
Address :
City :
State :
Zip :
Type of Business:
Position:
Duties and Responsibilities :
Telephone :	May you be contacted at work? Yes No

* Income : (from present occupation)	$ (ex. 300000, only numeric)
Other income :	$ (ex. 100000)
if other income, explain :
Own home or rent :	Own home Rent
* Your total assets :	$ (ex. 500000)
* Your total liabilities :	$ (ex.400000)
Mortgage :	$ (ex. 1000000)
* Amount of cash available for investment :	$ (ex. 4000000) Do you have a financing source? Yes No A amount of financing available : $ (ex. 2000000) Where :

* How did you first learn about the Migun Business Opportunity?
(Please indicate the person's name or which center you were referred.)

Have you ever been in business for yourself?

Would you devote full time to this business?

Do you plan to have a partner?

Yes No

if yes, will this person participate in the Migun operation?

* In which city and state are you interested?

1*. City: State:

2. City: State:

3. City: State:

Would you be willing to relocate?

When will you be able to open a Migun Demonstration Center?

What are some of the things that appeal to you most about the Migun business?

Additional information or comments?

Do you understand the functions of the Migun Demonstration Center?	Yes No
Do you understand the principles of the Migun Thermal Massage Bed?	Yes No
Do you understand the effects of the Migun Thermal Massage Bed?	Yes No
Do you have any other financial resources?	Yes No
Have you tried the Migun Thermal Massage Bed for at least a week on a daily basis?	Yes No

I certify that the information given is true to the best of my knowledge. I understand that this form does not obligate the parties in any matter and is intended only to assist in the evaluation of my candidacy to become a potential Migun business partner.