* All fields required

Contact Information


* First Name:
Middle Name:
* Last Name:
* Address:
* City:
* State:
* Zip:
* Country:
* E-Mail:
* Phone:
Cell Phone:
Work Phone:

Employment

Are you married?
Yes No
If yes, spouse's name
Will you have other owners/partners?
Yes No I don't know
If yes, please list partner's name(s)
If you are financially qualified, would you be interested in being an Area Director?
Yes No
Are you?
Self Employed or Employed
If yes to either of the above, please provide the following:

Name of your company or employer:

Position:

Type of Business:

Financial Information

Do you have $70,000 or more in liquid assets available?
Yes No
Do you have a $300,000 or more net worth?
Yes No
Is your credit score 649 or above?
Yes No

Personal Information

Has any applicant ever filed for bankruptcy protection?
Yes No
Has any applicant ever been convicted of a felony?
Yes No
Has any applicant ever had any suits, liens or judgements filed against them?
Yes No
Has any applicant ever had any suits, liens or judgements filed against them?
Yes No
Has the applicant ever been associated directly or indirectly with terrorist activities?
Yes No
If yes, list name of business and family relationship:
Are you or anyone in your immediate family currently under any form of non-competition agreement that limits your right to operate any type of business?
Yes No

Other Information

Are you a U.S. Citizen
Yes No
I have enough income to maintain my current lifestyle without spending funds allocated for development of my Blendz franchise(s) until opening
Yes No

Explanation

How did you hear about us?

I'm a customer Friend/Relative Radio Ad Blendz Website
In Store Brochure USA Today Magazine Article FranchiseGator.com
Received Card in Mail Wall Street Journal Yahoo Entrepreneur.com
Newspaper Classified Newspaper Article Google FranchiseForSale.com
Online Ad Entrepreneur Magazine Franchise.com Other Internet Site
Blendz Franchise Owner Television

Agreement

I understand that the acceptance of this Franchise Application by Blendz Franchise System, Inc. or any of it's affiliates (collectively "Blendz") does not constitute the grant of a franchise. I understand that Blendz grants franchises only by executing written franchise agreements. By signing below, I authorize Blendz and its assigns to start an investigative consumer report (including information regarding my character, general reputation, personal characteristics and mode of living) and credit investigation based on the information voluntarily provided by me and warrant that all information provided is true and accurate. I understand that I have a right to request that Blendz make a complete and accurate disclosure of the nature and scope of such investigation. Blendz may obtain my credit report in connection with this application. This is my authorization to credit reporting agencies, bank(s), creditors, and suppliers to release to Blendz, and to Blendz to release to such parties, all information requested regarding my depository, loan or other credit information including, without limitation, financial information, by telephone or in writing as part of the normal credit evaluation process. I release my bank(s), creditors, suppliers and Blendz from all liability with respect to the release of any such requested information. Authorization is granted to use photo or fax copies of my signature to obtain information. If I am requesting that Blendz make a credit determination based on my credit worthiness combined with any co-applicants, I authorize Blendz to discuss any derogatory credit items with such co-applicants. I understand that Blendz may, at any time, require that I sign an updated application or provide updated information. I acknowledge that I have read, and hereby agree to be bound by the Confidentiality and Non-Disclosure provisions which appear below.

CONFIDENTIALITY AND NON-DISCLOSURE

The individual who has signed the application on the reverse hereof (“Applicant”) has applied to become a franchisee of Blendz Franchise System, Inc. (“Blendz”) and, in connection with the application process, may become privy to certain information regarding the business of Blendz and its affiliates and its franchisees which Blendz classifies and protects as confidential and proprietary (the “Information”). Blendz is willing to divulge such information (as and to the extent it deems appropriate in connection with the Applicant’s application) only if the Applicant agrees to protect the confidentiality of such Information. In consideration of the disclosure of Information, Applicant agrees to the following terms and conditions:

1. Confidentiality. Applicant on behalf of itself and its affiliates, employees, officers and directors, agrees to maintain as confidential all Information disclosed to it. Applicant shall not, directly or indirectly, disclose any such Information to any third party without Blendz prior written consent, nor shall Applicant use any information for its own benefit (except for the purpose of the discussions contemplated by this Agreement) or for the benefit of any third party. The dissemination of Information by Applicant within its own organization shall be limited to those employees and consultants whose duties justify the need to know such Information.

2. Return of Information. Applicant shall return to Blendz within ten (10) days of written re­quest therefore, all Information, together with any and all copies thereof.

3. No Rights in Information. Neither this Agreement nor the disclosure of Information shall be deemed, by implication or otherwise, to vest in Applicant any rights in the Information or any other trade secrets or property of Blendz.

4. Breach. Any breach of any provision hereof will be theft of Blendz trade secrets, and will cause irreparable harm and damage to Blendz. Blendz shall be entitled to enjoin any actual or threat­ened violation of any of the provisions in this Agreement. In addition to injunctive relief, Blendz may recover damages from Applicant for any loss caused by any violation of the provisions of this Agreement (including violations by third parties to whom Applicant discloses Information). In any action brought to enforce any of the provisions of this Agreement, Blendz shall be entitled to reasonable attorneys fees and costs.

5. Severability. Any provision hereof which may prove unenforceable under any law or by any court shall not affect the validity of any other provision hereof.

By clicking on 'I accept' below you are agreeing to the above Agreement, and Confidentiality and Non-Disclosure.
 
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Blendz Franchise System, Inc. All rights reserved.
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