Franchise Application Form

FRANCHISE APPLICATION FORM

This Franchise Application Form is submitted on by Applicant Name: (Applicant) to Franchisor Name: (Franchisor).

RECITALS

WHEREAS, Franchisor owns and operates a system of businesses using proprietary marks, methods, procedures and training relating to the operation of franchises under the trade name and marks identified by Franchisor; and

WHEREAS, Applicant desires to obtain from Franchisor the right to operate a franchised business at identified locations under the Franchisor's system and may be required to enter into a separate Franchise Agreement subject to Franchisor's approval; and

WHEREAS, Franchisor requires completion of this application, and authorization to verify Applicant's financial condition, background, and other information prior to granting approval to enter into a Franchise Agreement.

NOW THEREFORE, Applicant submits the following information and makes the representations and authorizations set forth below for the purpose of evaluation by Franchisor.

1. APPLICANT INFORMATION

Individual    Corporation    Limited Liability Company    Partnership    Other

2. OWNERSHIP, BUSINESS EXPERIENCE, AND BACKGROUND

Have any principals ever been convicted of a felony?    Yes    No

Has any principal filed for bankruptcy within the past 10 years?    Yes    No

3. PROPOSED FRANCHISE LOCATION

Ownership/occupancy status:    Owned    Leased    To be secured

4. FINANCIAL INFORMATION

5. ACKNOWLEDGMENTS, AUTHORIZATIONS, AND CERTIFICATIONS

Applicant certifies that all information provided in this application is true, complete and correct to the best of Applicant's knowledge. Applicant acknowledges that Franchisor shall rely on this information in determining whether to approve Applicant for a franchise and that any material misstatement or omission may be grounds for denial of approval or termination of any subsequent Franchise Agreement.

Applicant authorizes Franchisor and its agents to obtain credit reports, background checks, criminal history, civil litigation searches, and employment and financial references. Applicant further authorizes banks, creditors, employers and references to disclose relevant information to Franchisor.

Applicant agrees to indemnify and hold Franchisor harmless from any claims, losses or damages arising from false statements or omissions in this application.

Confidentiality: All information submitted by Applicant is provided for Franchisor's evaluation. Franchisor may disclose such information to its affiliates, legal counsel, and financial institutions on a confidential basis as necessary for evaluation. Applicant acknowledges that Franchisor's disclosure of its system information to Applicant prior to execution of a Franchise Agreement remains the property of Franchisor and is subject to confidentiality obligations set by Franchisor.

Consent to Credit Check:    I consent to credit and background checks.    I do not consent.

6. APPLICATION FEE

Applicant acknowledges that submission of this application requires payment of a non‑refundable application fee in the amount set forth below. Payment of the application fee does not guarantee approval or the offer of a Franchise Agreement.

Applicant acknowledges that the application fee is earned upon receipt and is nonrefundable under all circumstances except as may be expressly stipulated in a subsequent written agreement between the parties.

7. TRADEMARKS, PROPRIETARY RIGHTS AND PRELIMINARY DISCLOSURES

Applicant acknowledges that any use of Franchisor's marks, trade secrets, manuals or other proprietary information prior to execution of a Franchise Agreement is prohibited unless expressly authorized in writing. If a Franchise Agreement is executed, Applicant will be granted only such rights and licenses as set forth in that agreement.

8. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

Governing Law: This application and any disputes arising from it shall be governed by the laws of the state selected by Franchisor in the Franchise Agreement to be offered, without regard to conflict of laws principles, except where otherwise required by mandatory local law.

Entire Agreement: This application constitutes the complete written record of Applicant's representations for the purpose of evaluation and supersedes all prior written or oral communications relating to the subject matter hereof. No binding franchise relationship shall arise from this application alone.

Severability: If any provision of this application is held to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.

9. AMENDMENTS; WAIVER; NOTICES; COUNTERPARTS

Amendments and Waiver: No amendment or waiver of any provision of this application shall be effective unless in writing signed by the party against whom enforcement is sought.

Notices: Any notices with respect to this application shall be delivered to the addresses set forth herein or such other address as a party may designate by written notice to the other.

Counterparts: This application may be executed in counterparts, each of which shall be deemed an original, but all of which together shall constitute one instrument.

10. CERTIFICATION

By signing below, Applicant certifies under penalty of perjury that the information provided in this application is true, complete, and correct; that Applicant understands submission of this application does not obligate Franchisor to enter into a Franchise Agreement; and that Applicant authorizes the disclosures and verifications described above.

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