| Date: |
|
| Name: |
Date of Birth
|
| Email: |
|
| Address: |
|
| Phone: |
|
| Cell Phone: |
|
| Best Time to Contact You: |
(Am)
(Pm) |
Marital Status:
|
Single
Married
Divorced
Children (Number) |
| Spouse's Name |
Date of Birth
|
| Ages of Children: |
|
| Do you have any health problems? If so, please describe: |
|
| Does your spouse have any health problems? If so, please describe: |
|
| Do you or your spouse have a background in Aquatics? If so, please describe: |
|
| Desired area for franchise (city and state) |
|
| Second choice of location (city and state) |
|
|
| PART 2 |
| Name of School |
|
| High School: |
Years Completed
Graduate
Degree
|
| College: |
Years Completed
Graduate
Degree
|
| Graduate School: |
Years Completed
Graduate
Degree
|
|
| PART 3 |
Please use the spaces below to list employment history within the past five years, or three positions held, starting with most current position. |
| Company:
|
Dates
Income
Position
|
| Company:
|
Dates
Income
Position
|
| Company:
|
Dates
Income
Position
|
| Company:
|
Dates
Income
Position
|
|
| PART 4 |
| Assets: |
|
| Checking and Savings: $
|
| Stocks and Bonds: $
|
| Real Estate Owned (Home): $
|
| Real Estate Owned (Other): $
|
| Other Assets (Describe):
|
| Totals Assets: $
|
| |
| Liabilities: |
| Notes Payable – Banks: $
|
| Notes Payable – Others: $
|
| Real Estate Mortgages Payable (Home): $
|
| Real Estate Mortgages Payable (Other): $
|
| Total Liablilities: $
|
| Net Worth: $
|
| |
| Other Sources of Income:
|
| Will you finance this business venture by cash or loan? If a loan, what is the collateral?
|
| If borrowed from individual, give name, address and occupation:
|
|
PART 5 |
| References: |
| Name:
|
Occupation
Address
Phone
|
| Name:
|
Occupation
Address
Phone
|
| Name:
|
Occupation
Address
Phone
|
| Name:
|
Occupation
Address
Phone
|
Credit: |
| Name:
|
Type of Account
Phone
|
| Name:
|
Type of Account
Phone
|
| Name:
|
Type of Account
Phone
|
|
Part 6 |
| Have you ever owned or do you presently own a business? If so, please give details: |
|
| Have you ever filed for bankruptcy, had a real estate loan foreclosed, or had any liens against you? If so, please explain |
|
| Have you ever made application for a bond which was refused?
|
| Have you ever been or are you now a party to any lawsuits? If so, please explain. |
|
|
I understand that the information provided in the Preliminary Information Form is confidential and affirm that it is true to the best of my knowledge. I understand that providing this information does not obligate me to purchase a franchise, nor does it obligate Kids First™ Swim Schools to offer a franchise to any person identified therein. I authorize Kids First™ Swim Schools, and/or any of its affiliates to conduct such investigations as it may deem necessary, in its sole business judgment, to verify or supplement any information provided in the Preliminary Information Form or any other information they may require me to provide as part of their evaluation of me as a prospective franchisee, and to update that information from time to time by conducting such other investigation as it may deem necessary, in its sole business judgment. I authorize Kids First™ Swim Schools, and/or any of its affiliates, to conduct to such personal financial or credit information investigations and to conduct such personal, credit, or financial background investigations on any individual therein identified, and to update or supplement that information from time to time by conducting such other investigations as it may deem necessary, in its sole business judgment. By submitting this Preliminary Information Form to Kids First™ Swim Schools, I am agreeing to the above terms. The undersigned hereby authorizes Kids First™ Swim Schools to order such credit reports as they may require on their behalf. In addition, I/We authorize the release of banking and credit information to Kids First™ Swim Schools for any references listed above or by any other references identified on any other types of preliminary information forms that they may require to supplement the information contained on this Preliminary Information Form. The undersigned hereby acknowledges that the above information is true and correct to the best his/her knowledge. |
| Name (Electronic Signature): |
|
| Date: |
|
| Name (Electronic Signature): |
|
| Date: |
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| |
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