Polígono Parc Activitats Econòmiques - C/ Tortosa 2 - 08500 Vic
Tel. 93 889 39 33 - Fax 93 886 38 26

To receive information regarding Cocoa Sampaka franchises, please fill out this form in as much detail as possible.
All information provided is strictly confidential and for the sole purpose of evaluating your profile to manage a Cacao Sampaka franchise. Completion of this form does not imply any obligation by either party.
Fields marked with (*) are required

Personal details

Surname *
Address *
City *
Business telephone number *
Email *
Date of birth
Marital status
Nº of sependent children
Name *
National ID / Business Tax ID *
Post code *
Country *
Private telephone number *
Fax *
Education *
Qualification obtained School / University / Centre Date

Professional details

Company Business activity and position Time
Do you have, or have you had your own business?
Company Business activity and position Time
If you play an active role in any of the above, please specify which, and the level of dedication involved:

Franchise information

Have you ever managed a franchise? If yes, please specify

Please indicate the area you would be interested in:
Please indicate the shop format you would be interested in:

Who do you expect to manage the business?

If a third party, please provide details on your degree of relationship

How do you plan to operate?

If a society, list the partners, their shareholdings and their involvement in managing the business.
Name % Position Responsibility

How did you hear about Cacao Sampaka?

Specify which

Financial information

How much capital do you have to launch the new business?

Need help getting bank funding?

Do you have premises to start your business? If yes, indicate whether leased or owned, the exact address and area in square metres.


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