Franchise Application

To apply for a franchise, please fill out this form. This is a secure website and form.

Personal Information

Your Full Name *

Home Address *

City *

State *

Zip Code *

How many years at your current residence? *

Phone *

Email *

Social Security Number *

Date of Birth *

Marital Status

Spouse's Name

Spouse's Occupation

Total Number of Dependents

Names & Ages of Dependents

Education

Last Year of School Completed *

Name of College or University

Degrees

Describe any training in sales, management, or retailing *

Criminal History

Have you ever been convicted of a misdemeanor? *

YesNo

If yes, explain

Have you ever been convicted of a felony? *

YesNo

If yes, explain

Business Experience

1. Most Recent

Present/Most Recent Position *

Company Name *

Dates Employed *

Company Address *

Phone *

May we contact this business? *

Describe duties, no. of employees supervised, and responsibilities *

Annual Income *

Reason you left *

2nd Most Recent

Position *

Company Name *

Dates Employed *

Company Address *

Phone *

May we contact this business? *

Describe duties, no. of employees supervised, and responsibilities *

Annual Income *

Reason you left *

3rd Most Recent

Position *

Company Name *

Dates Employed *

Company Address *

Phone *

May we contact this business? *

Describe duties, no. of employees supervised, and responsibilities *

Annual Income *

Reason you left *

Other Pertinent Business Information

Have you ever owned a business? If yes, state details *

List other branded or franchise, retail goods or services

Management Goals

Do you plan to devote full time to this venture? *

Are you willing to relocate? *

Do you plan to have equity partners? *

Geographic Area of Interest (please describe) *

What is your personal estimated net worth? *

Real Estate *

Cash *

Investments *

Other

Do you have any contingent liabilities, such as endorser, co-maker or guarantor? *

Have you or a company you owned ever been involved as a debtor in proceedings under the U.S. Bankruptcy Code? *

If yes, please explain

I submit the above information as my complete and true personal and financial condition as of the date shown below. In accordance with the Privacy Act (5 U.S.C. 552 a), Freedom of Information Act and The Fair Credit Reporting Act, I expressly authorize any past or present employer, any law enforcement agency, federal, state or local, or any person who has personal knowledge of my character, work experience or criminal records to release this information to Quench It Franchising, LLC.(“Franchisor”). I understand and acknowledge that, as a condition of being considered for the Quench It!® franchisee training program, I must submit to a credit history check to be performed by a credit reporting agency of Franchisor’s choice and authorizes and requests any consumer reporting agency to provide such information to Franchisor. I understand that the credit reporting agency will make the results of the credit history check available to Franchisor and that Franchisor may use those results as a factor in determining whether I will be granted a Quench It!® franchise. If requested by Franchisor, I agree to supply statements from my professional advisors (i.e., banker, broker, accountant or attorney) verifying the above assets, and I also agree to furnish copies of Federal Income Tax Returns as filed for the last five years. I understand that Franchisor is relying upon all the above information as a material factor in considering my application to become a Quench It!® franchisee, and I therefore agree to promptly notify Franchisor of any material change in any of the above information or any subsequent information provided to Franchisor. In addition, I release all persons from liability as a result of reporting true, accurate information. I also certify that neither I nor any of my funding sources, is or has ever been a terrorist or suspected terrorist, or a person or entity described in Section 1 of U.S. Executive Order 13224, issued September 23, 2001, as such persons and entities are further described at the Internet website www.ustrease.gov/offices/enforcement/ofac. I agree to comply with and/or to assist Franchisor to the fullest extent possible in Franchisor’s efforts to comply with the above law.

Signature (Write Full Name) *

Date *

Title *

Phone *

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