Franchise Application Form

Transcription

1 Franchise Application Form

2 Franchise Application Form Please complete and to Phone: Fax: Postal Address: PO Box 501, Concord, NSW, 2137 ABOUT YOU: Full Name: Home Address: Home Tel No: Daytime Tel No: Mobile Phone No: Address: Date of birth: Marital Status: (Circle one) Married / De facto/ Single / Widowed / Divorced What franchise area (Territory) are you interested in? How would you describe your health (Circle one) Good / Fair / Poor Is there any part of your health that could impact on your ability to operate the business? If yes please provide details. 2

3 Driving History: Do you have a driver license? How many demerit points remain on your license at this time? How many at fault accidents have you claimed on insurance in the last 5 years? Do you have any serious driving convictions DUI, Careless/Reckless Driving, Excess Speed more than 30km above speed limit? EMPLOYMENT HISTORY (Please attach any additional information if required) Do you have any customer service or B2B sales experience? If yes, please provide details Present employer Position in company Main duties Reason for leaving Previous employer Position in company Main duties Reason for leaving Do you currently run your own business: If yes, how long for Have you ever been involved in a business which has failed/ceased trading? If so, please give brief details Yes / No Yes / No (Circle) (Circle) Have you ever been declared a bankrupt? If yes please provide brief details including the date of discharge Have you had any convictions or legal proceedings against you? If so please provide details 3

4 WHY ART OF AQUARIA What interests you about becoming an Art of Aquaria Franchisee? What specifically attracts you to this business? Tell us the motivating factors behind wanting to own your own business. If you did want to join Art of Aquaria Franchise team when would you be ready to start? 4

5 FINANCES To successfully operate an Art of Aquaria Franchise you would need $ GST for a greenfield site and minimum of $ GST for an existing territory + working capital. Do you have access to these funds? Cash available $ Finance required $ Partial finance required % Statement of Assets and Liabilities Please list your assets: Cash (Bank) Real Estate Shares & Investments Others: Please list your liabilities: Mortgages Credit Cards Other debts What is your approximate Net worth? Cash flow What is your average monthly income What is your average monthly expenditure REFERENCES: Please supply the name and contact details of 2 professional references (i.e. accountant, lawyer, supplier, or employer) and 1 personal reference. References 1 (Professional/Trade/Business) Name Position Contact Number Relationship References 2 (Professional/Trade/Business) Name Position Contact Number Relationship References 3 (Personal) Name Position Contact Number Relationship 5

6 Declaration We Of Declares as follows: 1 I/We have answered the questions and provided the information in this form to the best of my/our knowledge and belief, and that as far as I am/we are aware the answers and information are true and correct in all respects and that no relevant details have been omitted. 2 I/We acknowledge that if any information included in this application is false or misleading in any way Art of Aquaria Franchise shall have the right to terminate any franchise agreement entered into on the basis of the information contained in this application. 3 I/We also acknowledge and agree that Art of Aquaria Franchise a. Is collecting the information contained in this application to assess whether I/we should be considered as a potential franchisee b. Is relying upon the information contained in this application as a material factor in considering this application c. Is authorised to contact any appropriate third parties to verify the accuracy of the information in this application and to retain any information obtained for its records d. May provide the information contained in this application to its advisers, including its accountants, lawyers and consultants e. May retain copies of this application for its records. Dated this day of 2017 Signature of Applicants/Persons to be approved 6

7 Questions If you have any questions or require clarification please contact: Peter on Phone: Privacy Disclosure Statement Art of Aquaria Franchise is committed to protecting your privacy. We collect your personal information (example name, address phone number, financial details, credit worthiness, business information and lease premise details) for you when you fill out one of Art of Aquaria Franchise Application forms and from telephone or via correspondence with you. We collect your personal information for the purpose of processing applications and assessing potential franchisees. If you do not provide us with your personal information we may not be able to process your application or deal with your request. We share your personal information only with the organisations that assist us in the provision of your services which you consent to (example landlords). In order to assist us to contact you, we store your personal information onto our database. By signing Art of Aquaria Franchise application form to which this statement is attached, you acknowledge that you have read this statement; consented to the collection, use and disclosure of your personal information in the manner and for the purpose set out in this statement. Please complete and to 7

8 PHONE FAX POSTAL ADDRESS PO Box 501, Concord, NSW, 2137