Franchise Application Form

*(Complete in full and do not use abbreviations.)

*The filling of this application does not oblige the application to become a franchise of Old town White Coffee.

Personal Information
Spouse Occupation
Total Dependant

Employment/Business Experience

What is Your Location Preference?

Do you plan to have equity partner?


If yes, complete the following

Equity Partner

Schedule A - Financial (Cash On Hand And In Bank)
Kindly attached the documents
Name of Bank / Financial Institution* Country* Amount*
Schedule B - Cash Value of Life Insurance
Kindly attached the documents
Name of Insurance Company* Face Amount* Cash Value*
Schedule C - Real Estate Owned
Kindly attached the documents
Description of Property* Name on Title* Purchase Price* Market Value* Balance Owed Mortgage Holder*


List three (3) References you have known at least 5 years.(Do not include relatives)

Name Address Relationship Contact No.

List all Business In Which You Have Financial Interest.

Name* Address* Position* Year Started* Shareholding Percentage(%)*

Personal Financial

Personal Financial Statements as of

I understand that the granting of franchise is at the sole discretion of Oldtown White Coffee.

I understand that I and/or representatives will have to be successfully complete Oldtown White Coffee's training program and competent to operate prior to the start of business operations.

I have read this application and everything I have stated in it is true. I understand that Oldtown White Coffee, in granting me a franchise, will rely upon the information provided by me.

I agree.


In line with the Personal Data Protection Act 2010, you are hereby informed that all the information provided by you in this form will be processed by us in accordance with the Personal Data Protection Notice (the Privacy Notice) that is available at our website []. By filling in this form, you are deemed to have read and understood the Privacy Notice and acknowledged and agreed to be bound by the terms of the Privacy Notice and you hereby consent to the processing of your Personal Data by us as described in the Notice.


Selaras dengan Akta Perlindungan Data Peribadi 2010, anda dimaklumkan bahawa semua maklumat yang diberikan oleh anda dalam borang ini akan diproses oleh kami mengikut Notis Perlindungan Data Peribadi (Notis Privasi) yang boleh didapati di laman web kami []. Dengan mengisi borang ini, anda dianggap telah membaca dan memahami Notis Privasi dan mengetahui dan bersetuju dengan terma-terma Notis Privasi, dan dengan ini anda bersetuju untuk pihak kami memproses Data Peribadi anda seperti yang dinyatakan dalam Notis


Pursuant to the Credit Reporting Agencies Act 2010 (“Act”), we and I/We, the following individuals whether as Individual or as Directors / Shareholders / Business Interest Parties do hereby give consent to you to obtain and/or disclose any Credit Information (as defined in the Act) relating to me/our company from and/or to RAM Credit Information Sdn Bhd or any source deemed appropriate to verify my/our credit history as you and/or RAM Credit Information Sdn Bhd or any source deemed appropriate may deem fit under any applicable law, regulation, guidelines,regulatory requirement or directive in relation to my/our company’s credit application or transaction with you for the following purposes (but not limited to) opening of account, credit evaluation, credit/account review, credit/account monitoring, debt recovery purposes, scoring solutions, legal
documentation and/or action consented to a contract or facility granted. Such consent shall remain applicable as long as I/our company am/is maintaining an account/loan/credit/any transaction with you

I agree.

I hereby authorise Oldtown White Coffee, its agent and all credit agencies, educational institutions, corporations, current and former employers, law enforcement and government agencies, city state, country and federal courts, military services and persons to release any information they may have about me to the company with which this has been field, or their agent.

I release Oldtown White Coffee and/or its agents and any person or entity which provided information pursuant to this information, from any and all liabilities, claims or lawsuits in regards to the information obtained from any and all referenced sources used.

I agree.


Option 2

You may download the form and mail the form to
Business Development Department,
Kopitiam Asia Pacific Sdn Bhd,
Lot 896, Jalan Subang 10, Taman Perindustrian Subang,
47600 Subang Jaya, Selangor, Malaysia.