SealMaster Online Franchise Application Form

Online Franchise Application Form...

PLEASE ANSWER ALL QUESTIONS.
This is not a contract and supplying or completing this form incurs no obligation on either party

PERSONAL INFORMATION
Last Name, First Name, Middle Name:
Social Security #:
Date Of Application:
Birthdate:
Age:
Telephone #:
Current Address:
City:
State:
Zip:
How Long?:
Previous Address:
City:
State:
Zip:
How Long?:
Height:
Weight:
Single/Married/Widowed:
Full Name Of Spouse:
Occupation Of Spouse:
Names And Ages Of Dependent Children:


APPLICANT'S FRANCHISE PLANS
Will The Franchise Be Owned And Operated By Yourself Or A Group?:
Please Explain Fully.
Amount Of Capital Available For This Business:
Describe Fully.
Territory For Which Application Made:
Would You Consider Any Other Area?
What Areas?


EDUCATION	PLEASE LIST ALL EDUCATION YOU HAVE RECEIVED INCLUDING HIGH SCHOOL, COLLEGE, MILITARY OR SPECIAL TRAINING.
1) Name Of School:
Dates Of Attendance (From - To):
Major And Minor Fields:
% Of Expenses Earned:
Location Of School:
Grade Average Or Class Standing:
Diploma Or Degree:
Date Of Graduation:
2) Name Of School:
Dates Of Attendance (From - To):
Major And Minor Fields:
% Of Expenses Earned:
Location Of School:
Grade Average Or Class Standing:
Diploma Or Degree:
Date Of Graduation:


BUSINESS AND EXPERIENCE RECORD	GIVE A COMPLETE RECORD OF YOUR EXPERIENCE, BEGINNING WITH YOUR PRESENT OR LAST POSITION, INCLUDING MILITARY SERVICE, INDICATE BY ASTERISK(*) THOSE EMPLOYERS YOU DO NOT WISH US TO CONTACT.
Have You Been In Business For Yourself?
1) Name And Address Of Employer:
Position, Title And Duties:
Dates Of Employment (From - To):
Supervisor's Name And Title:
Reason For Separation:
Beginning Salary:
Ending Salary:

2) Name And Address Of Employer:
Position, Title And Duties:
Dates Of Employment (From - To):
Supervisor's Name And Title:
Reason For Separation:
Beginning Salary:
Ending Salary:


PHYSICAL CONDITION
General Physical Condition:
Date Of Last Physical Exam:
List Any Physical Impairments Or Chronic Illnesses Which May Preclude Certain Types Of Activities:
Explain:


INCOME
Year:
Earned (salary, commission, fees, etc.):
Interest & Dividends Received:
Rents Received:
Other Income:
Other Income:
Other Income:
Other Income:
Other Income:

GROSS INCOME:


REFERENCES
Please List Three Professional And Character References Name, Address, Telephone
Please List Three Credit References Name, Address, Telephone
Bank References Name, Address
Checking Account?
Savings Account?
Other?


CONTINGENCIES
Do You Have Any Contingent Liabilities?
If So, Please Itemize:
Are Any Of Your Assets Pledged?
Are You A Defendant In Any Suits Or Legal Actions?
Have You Ever Taken Bankruptcy?


CONFIDENTIAL FINANCIAL STATEMENT
Date (include year):
(PLEASE ANSWER ALL QUESTIONS USING "NO" OR "NONE" WHERE NECESSARY)
• ASSETS
Cash on hand, and unrestricted in banks.: (See Sched. No.1)	$
U.S. Government Securities:
Accounts and Loans Receivable: (See Sched. No. 2)
Notes Received, Not Discounted: (See Sched. No. 2)
Notes Received, Discounted with Banks, Finance Companies, etc.: (See Sched. No. 2)
Life Insurance, Cash Surrender Value (Do not deduct loans): (See Sched. No. 3)
Other Stocks and Bonds: (See Sched. No. 4)
Real Estate: (See Sched. No. 5)
Automobiles Registered In Own Name:
Other Assets (itemize)

TOTAL ASSETS:	$


• LIABILITIES AND NET WORTH
Notes Payable to Banks. Unsecured Direct borrowing only.: (See Sched. No. 1)	$
Notes Payable to Banks. Secured Direct borrowing only.: (See Sched. No. 1)
Notes Receivable, Discounted with Banks, Finance Companies, etc.: (See Sched. No. 1)
Notes Payable to Others, Unsecured:
Loans Against Life Insurance: (See Sched. No. 3)
Accounts Payable:
Interest Payable:
Taxes and Assessments Payable: (See Sched. No. 5)
Mortgages Payable on Real Estate: (See Sched. No. 5)
Other Liabilities (itemize):

NET WORTH:	$
TOTAL LIABILITIES & NET WORTH:	$


SUPPLEMENTARY SCHEDULES
No. 1 BANKING RELATIONS (A list of all my bank accounts, including savings, and loans)
1) Name & Location Of Bank:
Cash Balance:
Amount Of Loan:
Maturity Of Loan:
How Endorsed, Guaranteed Or Secured:

2) Name & Location Of Bank:
Cash Balance:
Amount Of Loan:
Maturity Of Loan:
How Endorsed, Guaranteed Or Secured:

3) Name & Location Of Bank:
Cash Balance:
Amount Of Loan:
Maturity Of Loan:
How Endorsed, Guaranteed Or Secured:


No. 2 ACCOUNTS, LOANS & NOTES RECEIVABLE. (A list of the largest amounts owing to me)
1) Name & Address Of Debtor:
Amount Owing:
Age of Debt:
Description of Nature of Debt:
Description of Security Held:
Date Payment Expected:

2) Name & Address Of Debtor:
Amount Owing:
Age of Debt:
Description of Nature of Debt:
Description of Security Held:
Date Payment Expected:

3) Name & Address Of Debtor:
Amount Owing:
Age of Debt:
Description of Nature of Debt:
Description of Security Held:
Date Payment Expected:


No. 3 LIFE INSURANCE
1) Name of Person Insured:
Name of Beneficiary:
Name of Insurance Co.:
Type of Policy:
Face Amount of Policy:
Total Cash Surrender Value:
Total Loans Against Policy:
Amount of Yearly Premium:
Is Policy Assigned?

2) Name of Person Insured:
Name of Beneficiary:
Name of Insurance Co.:
Type of Policy:
Face Amount of Policy:
Total Cash Surrender Value:
Total Loans Against Policy:
Amount of Yearly Premium:
Is Policy Assigned?

3) Name of Person Insured:
Name of Beneficiary:
Name of Insurance Co.:
Type of Policy:
Face Amount of Policy:
Total Cash Surrender Value:
Total Loans Against Policy:
Amount of Yearly Premium:
Is Policy Assigned?


No. 4 Other Stocks & Bonds
1) Face Value (Bonds) No. of Shares (Stocks):
Description Of Security:
Registered In Name Of:
Cost:
Present Market Value:
Income Received Last Year:
To Whom Pledged:

2) Face Value (Bonds) No. of Shares (Stocks):
Description Of Security:
Registered In Name Of:
Cost:
Present Market Value:
Income Received Last Year:
To Whom Pledged:

3) Face Value (Bonds) No. of Shares (Stocks):
Description Of Security:
Registered In Name Of:
Cost:
Present Market Value:
Income Received Last Year:
To Whom Pledged:


No. 5 REAL ESTATE. The legal equitable title to all the real estate listed in this statement is solely in the name of the undersigned, except as follows:
1) Description or Street No.:
Dimensions or Acres:
Improvements Consist Of:
Mortgages or Liens:
Due Dates and Amounts of Payments:
Assessed Value:
Present Market Value:
Unpaid Taxes (Year and Amount):

2) Description or Street No.:
Dimensions or Acres:
Improvements Consist Of:
Mortgages or Liens:
Due Dates and Amounts of Payments:
Assessed Value:
Present Market Value:
Unpaid Taxes (Year and Amount):

3) Description or Street No.:
Dimensions or Acres:
Improvements Consist Of:
Mortgages or Liens:
Due Dates and Amounts of Payments:
Assessed Value:
Present Market Value:
Unpaid Taxes (Year and Amount):

4) Description or Street No.:
Dimensions or Acres:
Improvements Consist Of:
Mortgages or Liens:
Due Dates and Amounts of Payments:
Assessed Value:
Present Market Value:
Unpaid Taxes (Year and Amount):


In submitting the foregoing application and statement the undersigned guarantees its accuracy with the intent that it be relied upon in granting a franchise and extending credit to the undersigned and warrants that he/she has not knowingly witheld any information that might affect his/her credit risk, and the undersigned expressly agrees to notify Franchisor immediately in writing of any material change in his/her financial condition whether application for further credit is made or not and in the absence of such written notice, it is expressly agreed that Franchisor in granting a franchise or credit may rely on this statement as having the same force and effect as if delivered upon the date additional credit is requested or existing credit is extended or continued. OUR WEBSITE HAS NOT BEEN REVIEWED OR APPROVED BY THE CALIFORNIA DEPARTMENT OF CORPORATIONS. ANY COMPLAINTS CONCERNING THE CONTENT OF THIS WEBSITE MAY BE DIRECTED TO THE CALIFORNIA DEPARTMENT OF CORPORATIONS AT www.corp.ca.gov. The undersigned certifies that each part of the application and financial statements hereof and the information inserted herin has been carefully read and is true and correct.

Do You Agree to the above terms: (IMPORTANT: You must click the box to agree or we will refuse your application form)	YES, I AGREE! NO, I DO NOT AGREE!
Name:
Date:
IMPORTANT - PLEASE PRINT FOR YOUR RECORDS BEFORE CLICKING THE SUBMIT BUTTON BELOW!

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