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FRANCHISE
INFORMATION REQUEST
Amazing
Results specializes in high
quality Carpet & Upholstery
cleaning.
“
Confidential Franchise Application
Form
The completion of this application
places no obligation on Amazing
Results Cleaning Solutions
or the applicant.
Date ____________________________
Name ____________________________________
SIN# _________
- ______ - _____________
Date of Birth
___________________________
Name of Spouse/Domestic
Partner __________________________
SIN# _______________
Current Resident
Address _____________________________________________________
Mailing Address
if different ____________________________________________________
Telephone(s)
# _____________________________________________________________
Email Address:
_____________________________________________________________
Educational
Record:
High School
__________________________________
City ______________ Prov.
______
Circle last
grade completed: 9 10 11 12
13 Did you graduate? Yes ____
No ____
College or
University ____________________________
City ______________ Prov.
______
No. of years
completed ____________ Did
you graduate? Yes ____ No
____
Graduate
Experience/Degrees _________________________________________________
Additional
Education _________________________________________________________
Record of
Employment: (start with most
recent position)
Dates of
Employment: From __________________
to __________________ month/year
month/year
Employer
__________________________________________________________________
Name Address
Telephone
Type of Business
_________________________
Your Position _______________________
Supervisors
Name _____________________________
Your Salary: $ _________________
Describe
your duties and responsibilities:
_________________________________________
Will you
continue this position if
franchise is granted? ___________________________
Other Employment
information specific to this
Industry:
Your Position:
_______________________________________
Year: __________________
Your Position:
_______________________________________
Year: __________________
Which of
your past positions did you
enjoy the most? _______________________________
Have you
ever owned a business? _____
Name of Business _________________________
Address ___________________________________________________________________
Please give
details of your business
(What type? Do you still own
it?)__________________________________________________________________________
Have you
ever been self-employed? ______
If so, please give details
___________________________________________________
Are you a
partner or owner in any other
venture? If so, what is your
equity position in this venture?_________________________________
General Information:
What three
adjectives best describe your
personality?___________________
___________________ ___________________
What distinguishes
you from other people? __________________________________________________________________________
What do your
peers, co-workers and family
most admire about you? _______________________________________________________
Personal
References: (Do not list relatives
or former employers.)
Name Address
Phone
1. _______________________________________________________________________
2. _______________________________________________________________________
Credit References:
(Companies with whom you have
been done business)
Name Address
Phone
1. _______________________________________________________________________
2. _______________________________________________________________________
3. _______________________________________________________________________
FINANCIAL
STATEMENT:
Please do
not combine (if applicable)
non-spousal partner’s
financial information.
Assets Liabilities
Cash on hand
Mortgages - home
Securities
Mortgages –
Home (market
value) Notes Payable
Other Real
Estate Credit Cards
Personal
Property Operating Line
Business
Interests Other Liabilities
Other Assets
Total Assets
Total LiabilitiesWhat is the
maximum amount of cash that
you can
invest in Amazing Results
Cleaning Solutions franchise?
$______________
What is the
minimum income you need during
the first year in business?
$______________
List the
sources of capital you plan
to use to establish you’re
Amazing Results Cleaning
Solutions franchise: __________________________________
Investors/Associates
who would join in this venture:
(Please list and complete
the form for
each person)
Name Address
Percent of Ownership Percent
of time in business __________________________________________________________________
Number of
hours you intend to work in
the business: ___________
hrs/week
Would you
employ a full time Manager?
____________
Why are you
interested in an Amazing Results
Cleaning Solutions franchise?
____________________________________________________________
Have you
ever been convicted of a crime?
No ______ Yes ______ Date
___________
Should you
be selected to be awarded
an Amazing Results Cleaning
Solutions franchise,
when would you like to open
your business? __________________________
Geographic
area where you prefer a Franchise:__________________________________________________________________
(City) (Province)________________________________________________________________
(City) (Province)I
hereby certify that, all information
provided in this application
is true and correct
as of the date below.
I authorize
Amazing Results Cleaning Solutions,
or its affiliates or agents
to conduct any necessary
credit and/or reference checks,
and hereby waive my right
conferred upon me by statute
or otherwise regarding any
disclosures
obtained by Amazing Results
Cleaning Solutions or its
affiliates or agents. I understand
that any
false information or consequential
omission contained in this
application would be cause
for immediate termination
of any subsequent agreement
reached between myself and
Amazing Results Cleaning Solutions.
Applicant (and Spouse/Partner,
where applicable)
Signed: _____________________________________________
Date ______________
Signed: _____________________________________________
“Call
Us, You’ll be Amazed!’
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