Franchisee Application Information

Please complete the requested information below and press "Save My Application ". An asterisk * indicates required fields.

Application

Personal

Title

First Name*

Middle Name

Last Name*

Street Address*

City*

State*

Zip / Postal code*

Country*

Number of years at this Address*

Citizenship

Social Security Number*

Date of Birth*

Marital Status

	Single
	Married

E-mail address*

Home Phone*

Work Phone

Mobile Phone

Fax No

Are you Known by any other names?

May we contact you at work?

Yes

What is the best time to contact you?

IF YOU HAVE LIVED AT YOUR PRESENT ADDRESS LESS THAN 5 YEARS, PLEASE PROVIDE PRIOR ADDRESS INFORMATION

Street Address

City

State

Zip / Postal Code

Country

How Long?

Spouse

First Name

Middle Name

Last name

Citizenship

Date of Birth

Social Security Number

Number of Dependents

Ages

Education

High School Name

Date of Graduation

College / University Name

Years/Date of Graduation

Degree

College/University Name

Years/Date of Graduation

Degree

Current Employer

Company Name

Person Reporting to
First Name

Last Name

Dates of Employment From

Dates of Employment To

Current Position

Street Address

City

State

Zip / Postal Code

Country

Telephone

Annual Salary (In figures)

Prior Employer (1)

Company Name

Person Reporting to
First Name

Last Name

Dates of Employment From

Dates of Employment To

Current Position

Street Address

City

State

Zip / Postal Code

Country

Telephone

Annual Salary(In figures)

Prior Employer (2)

Company Name

Person Reporting to
First Name

Last Name

Dates of Employment From

Dates of Employment To

Current Position

Street Address

City

State

Zip / Postal code

Country

Telephone

Annual Salary(In figures)

Financial & Legal

Annual Salary/Wages(In figures)*

Commissions

Bonuses

Dividends

Real Estate
Income

Other (please identify)

Assets

Liabilities

Cash on Hand and in the banks*

Loans, Notes, Mortgages payable*

Stocks & Bonds*

Accounts / bills due *

Accounts/Notes Receivable *

Taxes Due*

Real Estate Investments *

Liens Payable*

Net Value of Business Owned*

Other Liabilities*

Other Assets*

1.	*The required initial investment ranges from approximately $29,900 to $49,900. Are you prepared to make an investment in this range?

Yes

2.	Do you have access to additional funds?

Yes

If so, please describe

3.	From which source of funds will this venture be financed?

4.	Have you ever been a part of any previous or current bankruptcy filings?

Yes

If yes, please explain

5.	Have you ever been arrested or convicted of a crime?

Yes

If yes, please explain

Business Experience, Management & Goals

1.	Have you ever been involved in a franchise?

Yes

If Yes, please explain.

2.	Have you ever owned, in whole or part, a business? If so, please explain your involvement.

Yes

If Yes, please explain your invlovement.

3.	Are you currently involved / participating in any other business ventures?

Yes

If Yes, please describe.

4.	Do you plan to devote full time effort to this franchise opportunity?

Yes

If No, please explain.

5.	Do you have any family members who would be actively involved in the franchise? If yes, name and relationship

Name

Relationship

6.	What interest you the most about the A-Pro System(s)?

7.	Please identify any partners/associates who would join you in this venture and their approximate percent of ownership (if applicable).

Name

Ownership(%)

Name

Ownership(%)

Name

Ownership(%)

Name

Ownership(%)

Name

Ownership(%)

Name

Ownership(%)

8.	If you are applying on behalf of a corporation please identify shareholders and respective percent of ownership.

Name

Ownership(%)

Name

Ownership(%)

Name

Ownership(%)

Name

Ownership(%)

Name

Ownership(%)

Name

Ownership(%)

9.	Why do you believe you can be successful operating an A-Pro franchise?

10.	In order of preference, where would you like to operate your A-Pro Franchise(s)

City*

Country

State/Province*

City

Country

State/Province

11.	How many A-Pro franchise territories would you like to operate?

12.	How did you first learn about our Franchise opportunity?* If referred by a A-Pro employee or Franchisee, please provide their name

13.	Your additional comments

UNDERSTAND THAT THIS IS NOT A CONTRACT AND THIS FORM INCURS NO OBLIGATION ON EITHER PARTY.

NOTE: By making an application with A-PRO it is understood that an investigative report may be prepared whereby information concerning my characteristics and mode of living may be obtained by A-PRO. Also an investigative report may be made of my credit standing by a consumer-reporting agency. In addition, an inquiry to appropriate agencies and databanks concerning my criminal background may be made. I authorize A-PRO to investigate all statements contained in my application for appointment and hereby release any source of information and A-PRO from any and all liability on account of furnishing such information to A-PRO. It is understood and agreed that my misrepresentation will be cause for cancellation of the application and /or termination of my franchise award, if granted. A photocopy of this may be regarded as the original and remain valid until revoked to me in writing.

I hereby certify that I have read and fully understand this consent to background verification and agree to be bound by its stipulations a on the date above. All the information stated here is a true and correct representation of my personal and financial condition. It is understood that the purpose of this questionnaire is to compile general information and that it is in no way binding upon either A-Pro or the candidate.

Certification

By choosing to submit this form electronically, I certify and agree that by entering my name in the space below, I bind and legally obligate myself to the same extent as I would by signing my name on a printed paper version of this form.

Signature