The information supplied by you will be held in the strictest confidence. The submission of this Request for Considertion does not obligate either party in any way, but is strictly for informational purposes.
Personal Information
If there is a partnership seeking a franchise award, each individual member must complete a copy of this Request for Consideration.
Name: [NamePrint]
Date of birth______________________
Spouse’s Name_________________________________________________________________________________
(first, middle, last)
Date of birth_______________________
Will your spouse be active in the business?___ No ____Yes, Full or Part Time?_______________
Number of Dependents___________________________Ages_____________________________________________
Home Phone (_________)_______________________________
Business Phone (__________)____________________________
Mobile Phone (________)________________________________
Spouse’s Mobile Phone(________)_________________________
Email: [EmailPrint]
Spouse’s Email_________________________________________
Present Address: [AddressPrint]
City, State & Zip: [CityStateZipPrint]
How long at present address? ______________years______________months
Do you own your own home? Yes □ No □
Previous Address_______________________________________________________________________________
City, State & Zip________________________________________________________________________
Hobbies or Interests______________________________________________________________________________
_____________________________________________________________________________________
Civic Interests__________________________________________________________________________
_____________________________________________________________________________________
What circumstances or event motivated you to investigate opening your own business?_____________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Referred By FranchiseCompany.com
Also referred by:________________________________________________________________________
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Assets |
Liabilities |
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Cash on Hand & Checking Account |
$_______________________ |
Credit Card Debt |
$_______________________ |
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Savings Account(s) |
$_______________________ |
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Loans Others Owe You (executed Promissary Note) |
$_______________________ |
Loans Payable to Others |
$_______________________ |
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Life Insurance Cash Surrender Value(not term insurance) |
$_______________________ |
Loans Against Life Insurance |
$_______________________ |
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Automobile(s) Value |
$_______________________ |
Automobile Loan(s) Balance |
$_______________________ |
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Stocks & Bonds(non-retirement) |
$_______________________ |
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401K/IRA/SEP |
$_______________________ |
Accounts Payable |
$_______________________ |
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Home Market Value |
$_______________________ |
Home Mortgage Balance |
$_______________________ |
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Other Real Estate Market Value |
$_______________________ |
Other Real Estate Loan Balance(s) |
$_______________________ |
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Other Assets |
$_______________________ |
Other Liabilities |
$_______________________ |
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Describe: |
Describe: |
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Total Assets: |
$_______________________ |
Total Liabilities: |
$_______________________ |
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Net Worth (Total Assets minus Total Liabilities): |
$_______________________ |
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Sources of Annual Income: |
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Source |
Salary |
Bonus & Commission |
Dividends |
Real Estate Income |
Other Income (describe) |
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Self |
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Spouse |
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Total Household Income |
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Sources of Capitol for Franchise Investment/ Down Payment: |
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1) |
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2) |
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3) |
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Please note that you may be asked by the Franchisor to supply proof of available funds at a later date.
Please list the names of all individuals (in addition to yourself) who will have ownership in the franchise or the entity that will own the franchise. (All equity owners listed will also be required to submit a completed Franchise Application)
_____________________________________________________________________________________
_____________________________________________________________________________________
o Check here if a resume is attached in lieu of completing the employment history below
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Employed By: |
No. of Years: |
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City: |
Annual Salary: $ |
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Phone # |
Commission: $ |
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Position/Responsibilities |
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o Check if current employer |
o Check if you were owner |
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Employed By: |
No. of Years: |
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City: |
Annual Salary: $ |
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Phone # |
Commission: $ |
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Position/Responsibilities |
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o Check if current employer |
o Check if you were owner |
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Employed By: |
No. of Years: |
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City: |
Annual Salary: $ |
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Phone # |
Commission: $ |
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Position/Responsibilities |
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o Check if current employer |
o Check if you were owner |
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Employed By: |
No. of Years: |
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City: |
Annual Salary: $ |
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Phone # |
Commission: $ |
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Position/Responsibilities |
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o Check if current employer |
o Check if you were owner |
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Employed By: |
No. of Years: |
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City: |
Annual Salary: $ |
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Phone # |
Commission: $ |
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Position/Responsibilities |
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o Check if current employer |
o Check if you were owner |
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Employed By: |
No. of Years: |
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City: |
Annual Salary: $ |
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Phone # |
Commission: $ |
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Position/Responsibilities |
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o Check if current employer |
o Check if you were owner |
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Name of Professional Reference |
Phone |
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Type of Professional Affiliation |
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Have you ever: |
Yes |
No |
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Been party to a lawsuit? |
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Filed Bankruptcy? |
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Had a real estate loan foreclosed? |
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Been convicted of a misdemeanor? |
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Been convicted of a felony? |
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Are you currently involved as a defendant in any litigation or arbitration proceeding? |
If yes, please explain: ___________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Interest in Franchise Opportunity:
What is the time commitment you are prepared to make for the success of your franchise location? oFull-Time oPart-Time oSecondary Business oInvestor Only
Will this business be your primary income?___yes___no Your spouse’s?___yes___no
What is your desired market?
1st Choice____________________________________________________________
City, State
2nd Choice____________________________________________________________
City, State
When would you be prepared to begin operating your franchise?__________________________
Month, Year
Why do you feel you would make a successful franchisee?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Other information you would like to share:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
I certify that the information that I have provided on this Request for Consideration is complete and correct. It is understood and agreed that any misrepresentation by me on this application will be sufficient cause for cancellation of this Request for Consideration and other legal remedies.
AGREED AND ACCEPTED BY:
_____________________________________________ DATE:_____________________
APPLICANT
_____________________________________________ DATE:_____________________
CO-APPLICANT SPOUSE
This application does not constitute an offer to sell a franchise. The offer of a franchise can only be made through the delivery of a FDD by the franchisor. Certain states require that the franchisor register the FDD in those states. The communications on this application are not directed to the residents of any of those states. Moreover, franchises are not offered in those states until the franchisor has registered the franchise (or obtained an applicable exemption from registration) and delivered the FDD to the prospective franchisee in compliance with applicable laws.