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Fillable Printable GNC Franchise Application Form

Fillable Printable GNC Franchise Application Form

GNC Franchise Application Form

GNC Franchise Application Form

GNC Franchise Application
FROM
LAST NAME FIRST NAME MIDDLE INITIAL
FRANCHISE APPLICATION - BEFORE YOU BEGIN
To ensure that you have all of the information needed to successfully complete the application a
checklist has been created to guide you in collecting all required information. Please have the
following ready before beginning the application process.
Type of Information Needed:Description:
Personal
Address, telephone, date of birth,
Social security number, driver's license number
Include information for spouse (if applicable)
Educational
Institution, address, dates attended, degree
Military
Branch, dates of service, rank, discharge status
Employment
Name, address, telephone, supervisor, dates of
employment, job title and responsibilities
Financial - Sources of Income/Assets
Cash, salary, investment income, credit cards, stocks
and bonds, real estate, IRA/401K plans, life
insurance, personal property
Financial - Liabilities
Banks, credit cards, mortgage, taxes, settlements
/judgments
Financial - Contingent Liabilities
Financial obligations as a third-party for leases,
contracts, legal claims, special debt
Business References (Bank or Supplier)
Name, address, telephone, etc. (for the past
two years)
Professional References
Name, address, telephone, occupation (minimum of
five years)
Credit References
Name, address, telephone (minimum of two
years credit history)
Much of this information can be obtained from your driver's license, bank statements, school
transcripts, military records, federal tax forms, articles of incorporation and other documents.
Please note: As part of the application process you will be required to submit a copy of your federal
tax return for the last two years as well as a copy of your driver’s license.
Once you have all of the information needed, please begin the application process.
APPLICATION
PLEASE COMPLETE ALL SECTIONS OF THIS FORM THOROUGHLY
PERSONAL INFORMATION
MR./MRS/MS.
LAST NAME
FIRST NAME
MIDDLE
SS#
DATE OF APPLICATION
BIRTHDATE
AGE
TELEPHONE NUMBER
HOME
WORK
CURRENT ADDRESS
CITY
STATE
ZIP
HOW LONG?
PREVIOUS ADDRESS
CITY
STATE
ZIP
HOW LONG?
MARITAL STATUS
SINGLE
MARRIED
WIDOWED
DIVORCED
EMAIL ADDRESS
COUNTRY OF BIRTH
ARE YOU A U.S. CITIZEN? YES
NO
FULL NAME OF SPOUSE
DAYTIME TELEPHONE
SPOUSE OCCUPATION
SPOUSE SOCIAL SECURITY #
BIRTHDATE OF SPOUSE
NAMES AND AGES OF DEPENDENT CHILDREN
HOW DID YOU FIRST LEARN ABOUT THE GNC FRANCHISE OPPORTUNITY?
YOUR PLANS FOR THE FRANCHISED BUSINESS
WHY ARE YOU LOOKING TO FRANCHISE A BUSINESS?
(NOTE: PLEASE INCLUDE A COPY OF THE ARTICLES OF INCORPORATION WITH THIS APPLICATION)
TOTAL FUNDS AVAILABLE FOR THE FRANCHISED BUSINESS, AND SOURCE(S) OF FUNDS:
GEOGRAPHIC AREA/ ADDRESS OF STORE FOR WHICH APPLICATION IS MADE:
OTHER AREAS YOU WOULD CONSIDER (1
ST
, 2
ND
, 3
RD
CHOICES):
HOW DO YOU PLAN ON ORGANIZING YOUR BUSINESS? PLEASE SELECT ONE:
WILL YOU INVEST IN THE FRANCHISE BUSINESS YOURSELF? OR WITH A PARTNER? EXPLAIN IN DETAIL.
SOLE PROPRIETORSHIP PARTNERSHIP CORPORATION
NOT SURE
PARTNER’S NAME, IF APPLICABLE: (NOTE: PARTNER MUST COMPLETE SEPARATE APPLICATION)
PLEASE PROVIDE THE NAME OF CORPORATION (IF APPLICABLE):
WILL YOU OPERATE THE FRANCHISE BUSINESS YOURSELF? EXPLAIN IN DETAIL.
PLEASE COMPLETE ALL SECTIONS OF THIS FORM THOROUGHLY
APPLICANT EDUCATIONAL AND MILITARY BACKGROUND
HIGH
NAME OF SCHOOL
LOCATION
DATES ATTENDED
SCHOOL
GRADE AVERAGE
HIGHEST LEVEL ACHIEVED
COLLEGE OR
NAME OF SCHOOL
LOCATION
DATES ATTENDED
VOCATIONAL
SCHOOL
MAJOR & MINOR FIELDS
DEGREE EARNED
HIGHEST LEVEL ACHIEVED
GRADUATE
NAME OF SCHOOL
LOCATION
DATES ATTENDED
SCHOOL
DEGREE EARNED
ADDITIONAL
PLEASE EXPLAIN
EDUCATION
MILITARY
EXPERIENCE
COUNTRY AND BRANCH OF SERVICE
DATES OF SERVICE
HIGHEST RANK ACHIEVED
DISCHARGE STATUS
SPOUSE EDUCATIONAL AND MILITARY BACKGROUND
HIGH
NAME OF SCHOOL
LOCATION
DATES ATTENDED
SCHOOL
GRADE AVERAGE
HIGHEST LEVEL ACHIEVED
COLLEGE OR
NAME OF SCHOOL
LOCATION
DATES ATTENDED
VOCATIONAL
SCHOOL
MAJOR & MINOR FIELDS
DEGREE EARNED
HIGHEST LEVEL ACHIEVED
GRADUATE
NAME OF SCHOOL
LOCATION
DATES ATTENDED
SCHOOL
DEGREE EARNED
ADDITIONAL
PLEASE EXPLAIN
EDUCATION
MILITARY
EXPERIENCE
COUNTRY AND BRANCH OF SERVICE
DATES OF SERVICE
HIGHEST RANK ACHIEVED
DISCHARGE STATUS
Turn Wellness into
Wealth
PLEASE COMPLETE ALL SECTIONS OF THIS FORM THOROUGHLY
EMPLOYMENT HISTORY
APPLICANT
SPOUSE
CURRENT EMPLOYER
TELEPHONE NUMBER
CURRENT EMPLOYER
TELEPHONE NUMBER
STREET ADDRESS
STREET ADDRESS
CITY
STATE
ZIP
CITY
STATE
ZIP
JOB TITLE AND RESPONSIBILITIES
JOB TITLE AND RESPONSIBILITIES
SUPERVISOR’S NAME AND POSITION
SUPERVISOR’S NAME AND POSITION
MAY WE CONTACT?
MAY WE CONTACT?
DATES OF EMPLOYMENT
DATES OF EMPLOYMENT
FROM
TO
FROM
TO
REASONS FOR LEAVING
REASONS FOR LEAVING
STARTING SALARY
ENDING SALARY
STARTING SALARY
ENDING SALARY
PREVIOUS EMPLOYER
TELEPHONE NUMBER
PREVIOUS EMPLOYER
TELEPHONE NUMBER
STREET ADDRESS
STREET ADDRESS
CITY STATE ZIP
CITY STATE ZIP
JOB TITLE AND RESPONSIBILITIES
JOB TITLE AND RESPONSIBILITIES
SUPERVISOR’S NAME AND POSITION
SUPERVISOR’S NAME AND POSITION
DATES OF EMPLOYMENT
DATES OF EMPLOYMENT
REASONS FOR LEAVING
REASONS FOR LEAVING
STARTING SALARY
ENDING SALARY
STARTING SALARY
ENDING SALARY
PREVIOUS EMPLOYER TELEPHONE NUMBER
PREVIOUS EMPLOYER TELEPHONE NUMBER
STREET ADDRESS
STREET ADDRESS
CITY STATE ZIP
CITY STATE ZIP
JOB TITLE AND RESPONSIBILITIES
JOB TITLE AND RESPONSIBILITIES
SUPERVISOR’S NAME AND POSITION
SUPERVISOR’S NAME AND POSITION
DATES OF EMPLOYMENT
DATES OF EMPLOYMENT
REASONS FOR LEAVING
REASONS FOR LEAVING
STARTING SALARY
ENDING SALARY
STARTING SALARY
ENDING SALARY
PLEASE COMPLETE ALL SECTIONS OF THIS FORM THOROUGHLY
CONFIDENTIAL PERSONAL FINANCIAL STATEMENT
Please complete all sections of this form thoroughly
(Include ALL assets and liabilities)
ASSETS (In Dollars)
LIABILITIES (In Dollars)
Monthly
Payments
Balance
Owed
CASH ON HAND AND IN BANKS UNRESTRICTED
(Schedule E)
NOTES PAYABLE TO BANKS
(Schedule D)
U.S. GOVERNMENT AND MARKETABLE SECURITIES
(Schedule A)
CREDIT CARDS
(Schedule D
)
NON-MARKETABLE SECURITIES
(
Schedule A)
PAYABLE TO OTHERS
(ScheduleD )
REAL ESTATE
(Schedule B)
ACCOUNTS AND BILLS DUE
IRA/401K
(Use Schedules A and/or E, as appropriate)
REAL ESTATE MORTGAGES
(Schedule B)
CASH SURRENDER VALUE OF LIFE INSURANCE
(Schedule C)
UNPAID TAXES
(Not Death Benefit)
LOANS RECEIVABLE
UNPAID INTEREST
PERSONAL PROPERTY, PRESENT VALUE
AMOUNTS DUE FOR SETTLEMENTS, JUDGEMENTS
AUTOMOBILE(S), PRESENT VALUE
INSURANCE PREMIUMS
OTHER ASSETS – ITEMIZE
OTHER LIABILITIES - ITEMIZE
NET VALUE OF BUSINESS
(Attach most recent financial statement)
TOTAL MONTHLY PAYMENTS
$
PLEASE REMEMBER TO ATTACH YOUR LAST
TWO YEARS’ FEDERAL INCOME TAX RETURNS
TOTAL LIABILITIES
$
NET WORTH
(TOTAL ASSETS) MINUS TOTAL LIABILITIES
$
TOTAL ASSETS
$
TOTAL LIABILITIES & NET WORTH
$
CONTINGENT LIABILITIES
AS ENDORSER, CO-MAKER OR GUARANTOR
ON LEASES OR CONTRACTS
UNDER LEGAL CLAIMS
OTHER SPECIAL DEBT
AMOUNT OF CONTESTED INCOME, PROPERTY OR TAX LIEN
PLEASE COMPLETE ALL SECTIONS OF THIS FORM THOROUGHLY
SCHEDULES
SCHEDULE A – U.S. GOVERNMENT, MARKETABLE AND NON-MARKETABLE STOCKS AND BONDS
NO. OF SHARES/
ARE
FACE VALUE
THESE
MONTHLY
MARKET
OF BONDS
DESCRIPTION
IN NAME OF
PLEDGED?
INCOME
VALUE
SCHEDULE B – REAL ESTATE OWNED
DATE
ASSESSED
MARKET
MORTGAGE
MONTHLY
RENTAL
DESCRIPTION
ACQUIRED
MORTGAGE HOLDER
COST
VALUE
VALUE
BALANCE
PAYMENT
INCOME
YOUR RESIDENCE
OTHER
OTHER
OTHER
SCHEDULE C – LIFE INSURANCE CARRIED
CASH
FACE
POLICY
SURRENDER
NAME OF INSURANCE COMPANY
OWNER
BENEFICIARY
AMOUNT
LOANS
VALUE
SCHEDULE D – BANKS, FINANCE COMPANIES AND CREDIT CARDS WHERE CREDIT HAS BEEN OBTAINED
NAME AND ADDRESS OF LENDER
CREDIT IN THE NAME OF
SECURED OR
UNSECURED
CURRENT
BALANCE
SCHEDULE E – CASH IN BANKS OR OTHER ACCOUNTS
ACCOUNT
CURRENT
FINANCIAL INSTITUTION
BRANCH
ACCOUNT NUMBER
TYPE
BALANCE
ffff
DSDF
SALARY, BONUSES AND COMMISSIONS
INVESTMENT INCOME
REAL ESTATE INCOME
$AMOUNT
$AMOUNT
$AMOUNT
PER MONTH
PER MONTH
PER MONTH
SOURCES OF INCOME FOR YEAR ENDED DECEMBER 31
BUSINESS REFERENCES—TWO YEAR HISTORY
CONTACT
CONTACT
CONTACT
CONTACT
CONTACT
TELEPHONE
$AMOUNT
$AMOUNT
$AMOUNT
$AMOUNT
PER MONTH
PER MONTH
PER MONTH
PER MONTH
OTHER INCOME
(ALIMONY, CHILD SUPPORT OR SEPARATE MAINTENANCE INCOME NEED NOT BE
REVEALED IF YOU DO NO WISH TO HAVE IT CONSIDERED AS A BASIS FOR REPAYING
AN OBLIGATION)
SPOUSE’S SALARY, BONUSES AND COMMISSIONS
SPOUSE’S OTHER INCOME
TOTAL INCOME
LEGAL NAME OF ENTITY:
HAVE YOU EVER DECLARED BANKRUPTCY? EXPLAIN.
ARE YOU OR YOUR SPOUSE CURRENTLY SELF-EMPLOYED?
TELEPHONE
ADDRESS:
DESCRIBE THE NATURE OF BUSINESS AND YOUR ACTIVITIES:
HAVE YOU OR YOUR SPOUSE BEEN A PARTNER OR AN OFFICER IN ANY OTHER BUSINESS? PLEASE EXPLAIN.
HAVE YOU OR YOUR SPOUSE BEEN SUBJECT TO ANY LITIGATION OR JUDGMENTS? PLEASE EXPLAIN.
HAVE YOU OR YOUR SPOUSE BEEN A DEFENDANT IN ANY SUITS OR LEGAL ACTIONS? PLEASE EXPLAIN.
HAVE YOU EVER PLEADED GUILTY TO OR BEEN CONVICTED OF A CRIME OTHER THAN A TRAFFIC VIOLATION OR SUMMARY OF OFFENSE? IF “YES” PLEASE EXPLAIN FULLY.
NOTE: A CONVICTION DOES NOT AUTOMATICALLY MEAN THAT YOU WILL NOT BE OFFERED A FRANCHISE. THE NATURE OF YOUR CONVICTION AND HOW LONG AGO ARE IMPORTANT. GIVE ALL THE FACTS SO THAT A DECISION CAN BE PROPERLY MADE.
TELEPHONE
TELEPHONE
TELEPHONE
TELEPHONE
NAME OF BANK BRANCH
NAME OF BANK BRANCH
NAME OF SUPPLIER ADDRESS
NAME OF SUPPLIER ADDRESS
NAME OF SUPPLIER ADDRESS
LIST THREE PROFESSIONAL AND CHARACTER REFERENCES WHO HAVE KNOWN YOU WELL FOR AT LEAST FIVE YEARS
TELEPHONE
YRS. KNOWN
TELEPHONE CONTACT PERSON
FULL ADDRESS
NAME
NAME FULL ADDRESS
OCCUPATION
LIST THREE CREDIT REFERENCES WITH WHICHYOU HAVE AT LEAST TWO YEARS’ CREDIT HISTORY
LEGAL HISTORY
20
(*PLEASE INLCUDE A PHOTOCOPY OF CURRENT DRIVER’S LICENSE WITH THIS APPLICATION)
Thank you for your interest in the GNC Franchise Opportunity. We look forward to receipt of this application and further discussing
our franchise program with you.
General Nutrition Corporation
300 Sixth Avenue, Pittsburgh, PA 15222
Phone: 1-800-766-7099 Fax: 412-402-7105 Email: [email protected]
APPLICANT SIGNATURE
DATE
*DRIVER’S LICENSE NUMBER STATE EXPIRATION
SPOUSE (IF APPLICABLE)
SPOUSE SIGNATURE DATE
*DRIVER’S LICENSE NUMBER STATE EXPIRATION
RELEASE AND AUTHORIZATION
I HEREBY AUTHORIZE GENERAL NUTRITION CORPORATION TO INVESTIGATE MY BACKGROUND AND QUALIFICATIONS FOR PURPOSES OF
EVALUATING MY QUALIFICATIONS TO BE A GENERAL NUTRITION CORPORATION FRANCHISEE. I UNDERSTAND THAT SUCH INVESTIGATION
MAY INCLUDE AN INVESTIGATIVE CONSUMER REPORT, AS WELL AS A GENERAL BACKGROUND SEARCH AND AN INVESTIGATION IN
ACCORDANCE WITH ANTI-TERRORISM LEGISLATION, SUCH AS THE USA PATRIOT ACT AND EXECUTIVE ORDER 13224 ENACTED BY THE U.S.
GOVERNMENT. I UNDERSTAND THAT THESE INVESTIGATIONS MAY REVEAL INFORMATION AS TO MY CREDITWORTHINESS, CREDIT
STANDING, CREDIT CAPACITY, CHARACTER, GENERAL REPUTATION, PERSONAL CHARACTERISTICS AND MODE OF LIVING. ACCORDINGLY, I
VOLUNTARILY AND KNOWINGLY AUTHORIZE ANY PRESENT OR PAST EMPLOYER OR SUPERVISOR, LAW ENFORCEMENT AGENCY, STATE OR
FEDERAL AGENCY, CREDIT BUREAU, COLLECTION AGENCY, BANKING INSTITUTION, PRIVATE BUSINESS, MILITARY BRANCH OR THE
NATIONAL PERSONNEL RECORDS CENTER, AND/OR OTHER PERSONS TO GIVE RECORDS OR INFORMATION THEY MAY HAVE CONCERNING
MY LOAN BALANCES, CRIMINAL HISTORY, AND EMPLOYMENT RECORDS OR ANY OTHER INFORMATION REQUESTED, TO GENERAL
NUTRITION CORPORATION AND/OR ITS PARENT COMPANIES, SUBSIDIARIES OR AGENTS. I VOLUNTARILY AND KNOWINGLY AND
UNCONDITIONALLY RELEASE ANY OF THE ABOVE NAMED AGENCIES AND/OR INDIVIDUALS FROM ANY AND ALL LIABILITY RESULTING FROM
FURNISHING THIS INFORMATION.
I UNDERSTAND THAT UPON WRITTEN REQUEST, GENERAL NUTRITION CORPORATION WILL MAKE AVAILABLE TO ME A COMPLETE AND
ACCURATE DISCLOSURE OF THE NATURE AND SCOPE OF THE INVESTIGATION REQUESTED, AS WELL AS A COPY OF A SUMMARY OF MY
RIGHTS AS A CONSUMER UNDER THE FAIR CREDIT REPORTING ACT.
THE INFORMATION CONTAINED IN THIS APPLICATION IS PROVIDED FOR THE PURPOSE OF OBTAINING A FRANCHISE AND/OR CREDIT, OR
EXTENDING OR MAINTAINING CREDIT WITH FRANCHISOR ON BEHALF OF THE UNDERSIGNED.
I UNDERSTAND THAT, IF I AM APPROVED TO BECOME A GENERAL NUTRITION CORPORATION FRANCHISEE, GENERAL NUTRITION
CORPORATION MAY RELY ON THIS AUTHORIZATION AND HAVE ADDITIONAL BACKGROUND CHECKS CONDUCTED DURING AND
THROUGHOUT THE TERM OF MY FRANCHISE AGREEMENT WITHOUT ASKING FOR MY AUTHORIZATION AGAIN.
THE UNDERSIGNED EXPRESSLY AGREE(S) TO NOTIFY FRANCHISOR IMMEDIATELY IN WRITING OF ANY MATERIAL CHANGE IN HIS/HER/THEIR
FINANCIAL CONDITION WHETHER APPLICATION FOR FURTHER CREDIT IS MADE OR NOT.
THE UNDERSIGNED CERTIFIES THAT EACH PART OF THE APPLICATION AND FINANCIAL STATEMENTS HEREOF AND THE INFORMATION
INSERTED HEREIN HAS BEEN CAREFULLY READ AND IS TRUE AND CORRECT. THE UNDERSIGNED FURTHER ACKNOWLEDGES AND AGREES
THAT THE GRANTING OF A FRANCHISE IS AT THE SOLE DISCRETION OF GENERAL NUTRITION CORPORATION AND THAT THE FILING OF THIS
APPLICATION DOES NOT OBLIGATE THE APPLICANT TO PURCHASE OR GENERAL NUTRITION CORPORATION TO SELL A FRANCHISE OR
LOCATION.
ACCORDING TO THE FAIR CREDIT REPORTING ACT, I AM ENTITLED TO KNOW IF CREDIT IS DENIED BECAUSE OF INFORMATION OBTAINED
FROM A CONSUMER REPORTING AGENCY. I WILL BE SO ADVISED AND GIVEN THE NAME OF THE AGENCY OR SOURCE OF INFORMATION.
A PHOTOCOPY OF THIS RELEASE WILL BE VALID AS AN ORIGINAL EVEN THOUGH THE SAID PHOTOCOPY
DOES NOT CONTAIN AN ORIGINAL WRITTEN SIGNATURE.
APPLICANT
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