Name:
*
First Name
Last Name
Email:
*
Phone:
*
(###)
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When is the best time to contact you?
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Name:
First Name
Last Name
Email:
Phone:
(###)
###
####
Current Address:
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Are you a citizen of the U.S.?
*
Are you legal age in your state and/or area of residence?
*
Have you ever been convicted of a felony?
*
School Attended:
# of Years Attended:
Grade or Degree Attained:
School Attended:
# of Years Attended:
Grade or Degree Attained:
School Attended:
# of Years Attended:
Grade or Degree Attained:
Current Employer:
*
# of Years Employed Here:
*
Are you self-employed?
*
Business Address:
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Business Phone:
*
(###)
###
####
Current Position:
*
Nature of Business:
*
May be contacted at work?
*
1. Reference Name
*
First Name
Last Name
Phone:
*
(###)
###
####
2. Reference Name:
*
First Name
Last Name
Phone:
*
(###)
###
####
3. Reference Name:
*
First Name
Last Name
Phone:
*
(###)
###
####
Present Occupation Annual Salary:
*
Other Annual Income:
If "other" income, please explain.
Would this business be your sole source of income?
*
Do you own or rent your home?
*
If you own, what is your home's current value?
Mortgage/Rent Payment:
*
Total Assets:
*
Your Total Liabilities:
*
Amount of Available Cash for Investing:
*
Net Worth:
*
What is your current credit score?
*
Do you have a financing source?
*
Amount of Financing Available:
If qualified, when would you be ready to franchise?
*
MM
DD
YYYY
Area Preference:
*
Will you be the sole owner of this business?
*
Terms & Conditions
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I understand the granting of a Franchise is at the sole discretion of the Franchisor (Petro’s Franchising Group, LLC).
I understand that the information I receive from the Franchisor, or from any employee, agent, or franchisee of the Franchisor, is highly confidential (“Confidential Information”) and has been developed with a great deal of effort and expense to the Franchisor and is being made available to me solely because of this Franchise Application for Additional Information. I agree that I shall treat and maintain all Confidential Information as confidential, and I shall not, at any time, without the express written consent of the board of directors of the Franchisor, disclose, publish, or divulge any Confidential Information to any person, firm, corporation or entity, or use any Confidential Information, directly or indirectly, for my own benefit or the benefit of any person, firm, corporation or other entity, other than the Franchisor.
I authorize the procurement of an investigative consumer report and understand that it may contain information about my background, character, general reputation, mode of living, credit worthiness and job performance. I understand that, upon written request within a reasonable period of time, I am entitled to additional information concerning the nature and scope of this investigation. I hereby release a credit bureau or security consultant selected by the franchisor and Petro’s Chili & Chips, LLC, their officers, agents, employees and servants from any liability arising from preparation of this report or investigation relating thereto.
This authorization for release of information includes, but is not limited to, matters of opinion relating to my character, ability, reputation, and past performance. I authorize all persons, schools, companies, corporations, credit bureaus, and law enforcement agencies to release such information without restriction or qualification to a credit bureau or security consultant selected by the franchisor and Petro’s Chili & Chips, LLC, and any of their officers, agents, employees and servants. I voluntarily waive all recourse and release them from liability for complying with this authorization. This authorization/release shall apply to this as well as any future request for an investigative consumer report by the above named firm. I authorize that a photocopy or facsimile of this release be considered as valid as the original.
I agree that I will settle any and all previously unasserted claims, disputes or controversies arising out of or relating to my Franchise Application for Additional Information or candidacy for the grant of Petro’s Chili & Chips franchise from Franchisor, exclusively final and binding arbitration in accordance with the Commercial Arbitration Rules of the American Arbitration Association (the “AAA”) at a hearing to be administered by the AAA to be held at Nashville, Tennessee or in such location in the state of Tennessee designated by the AAA. Such claims include, but are not limited to, claims under federal, state, and local statutory or common law, such as the Age Discrimination in Employment Act; Title VII of the Civil Rights Act of 1964, as amended, including the amendments of the Civil Rights Act of 1991; the Americans with Disabilities Act; the law of contract and law of tort.
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