Franchise Application

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REQUEST FRANCHISE INFO


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First Name Last Name
Address City
State/Province Zip Code
Phone Number Cell - Business Number
Best time to call Best place to call
Any Morning Afternoon Evening Home Cell Business
Fax # Email Address
American Citizen If no, please explain
Yes No
Marital Status If married, spouse's name and occupation:
Single Married Divorced
Will your spouse be in business with you ? Number of children/dependents
Yes No
Education How did you hear about Rejuvenate?
Present Employment: Present Income
Job Description Have you ever owned your own business ?
Yes No
When are you ready to start your new business?
Now 30 days 60 days 90 days 6 Months 1 Year
City /State 1st Location 2nd choice - 3rd choice
What is the reason you want to start your own business ?
In owning your own business what are you expecting or looking for ?
What do you feel your strengths are ?
What do you feel your weaknesses are ?
Any other information that would help find the best suited business for your goals
Full time or part- time business Family or friends involved in business
Full time Part Time Investment Yes No If so, whom?
FINANCIAL INFORMATION
Cash in checking account Mortgage home
Cash in savings account
Mortgage other
Stocks/bonds Notes to banks
IRA accounts Other notes due
401k's Credit cards
Real Estate home (value) Taxes due
Real Estate other Auto's due
Automobiles All other liabilities
If business owner (value) All other assets
TOTAL ASSETS TOTAL LIABILITIES
Your Net worth take total assets minus total liabilities
Your total liquid capital to invest in your business
Your ability to finance the balance of your business. How Much?
Total Investment
Do you have any other source of investment capital?
If you answered yes, please explain

All the information stated herein is a true and correct representation of my personal and financial condition. It is understood that the purpose of this questionnaire is to gather basic information and that it is in no way binding upon Rejuvenate Health and Fitness. THIS IS NOT A CONTRACT. Please submit this form and also Download Questionnaire









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The Zoo Health Club Ft. Lauderdale
3001 S.E. 5th Street Fort Lauderdale, FL, 33316 Phone: (954) 525-7010
CLUB HOURS Mon–Thu: 5:30am -10pm Fri: 5:30am–9pm Sat: 8am–7pm Sun: 8am–5pm