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Franchise Application
To apply for a franchise, please fill out this form. This is a secure website and form.
Personal Information
Your Full Name
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Home Address
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City
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State
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New Jersey
New Mexico
New York
North Carolina
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Ohio
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Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Zip Code
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How many years at your current residence?
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Phone
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Email
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Social Security Number
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Date of Birth
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Marital Status
Spouse's Name
Spouse's Occupation
Total Number of Dependents
Names & Ages of Dependents
Education
Last Year of School Completed
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Name of College or University
Degrees
Describe any training in sales, management, or retailing
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Criminal History
Have you ever been convicted of a misdemeanor?
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Yes
No
If yes, explain
Have you ever been convicted of a felony?
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Yes
No
If yes, explain
Business Experience
1. Most Recent
Present/Most Recent Position
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Company Name
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Dates Employed
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Company Address
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Phone
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May we contact this business?
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Describe duties, no. of employees supervised, and responsibilities
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Annual Income
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Reason you left
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2nd Most Recent
Position
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Company Name
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Dates Employed
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Company Address
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Phone
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May we contact this business?
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Describe duties, no. of employees supervised, and responsibilities
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Annual Income
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Reason you left
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3rd Most Recent
Position
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Company Name
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Dates Employed
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Company Address
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Phone
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May we contact this business?
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Describe duties, no. of employees supervised, and responsibilities
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Annual Income
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Reason you left
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Other Pertinent Business Information
Have you ever owned a business? If yes, state details
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List other branded or franchise, retail goods or services
Management Goals
Do you plan to devote full time to this venture?
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Are you willing to relocate?
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Do you plan to have equity partners?
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Geographic Area of Interest (please describe)
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Please briefly describe why you want to become a Quench It!® Franchisee
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List any hobbies, community activities, special interests or other pertinent information
References
List two (2) personal and two (2) business references you have known at least two years (not former employers or relatives).
1st Personal Reference
Name
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Address
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Relationship
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Phone Number
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2nd Personal Reference
Name
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Address
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Relationship
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Phone Number
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1st Business Reference
Name
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Address
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Relationship
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Phone Number
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2nd Business Reference
Name
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Address
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Relationship
*
Phone Number
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Personal Financial Statement
What is your personal estimated net worth?
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Real Estate
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Cash
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Investments
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Other
Do you have any contingent liabilities, such as endorser, co-maker or guarantor?
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Have you or a company you owned ever been involved as a debtor in proceedings under the U.S. Bankruptcy Code?
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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)
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Date
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Title
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Phone
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