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Pre-Qualification Application

Tell us More About You!

Note: Completing this form does not place any obligation on the applicant to purchase or the franchisor to sell the franchise to the applicant. To expedite processing of your application, please ensure that all the information is provided as requested. Where information is not available or applicable, please indicate accordingly. All information will be kept strictly confidential.

Franchise Applicant’s Personal Particulars

Full Name:(Required)
Home Address:(Required)
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Sex:

Employment / Business History

(Please provide details of your employment status or business that you own)
(Name of company)
Business Address:(Required)
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(For business owned, please describe business structure and duties)
(Name of company)
Business Address:
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Financial Information

(Please provide source of funding infomation)
(Personal Savings, Line of Credit, Bank Loan, etc)
Do you plan to use financing?

Entity/Geographic Information

(Please provide details of general entity/geographical information)
(Substance Abuse Program (SAP),Transitional Housing Program (THP), Outpatient Services (OPS), Adult Residential Facilities (ARF)
(City, State, County, etc)
As part of the franchise pre-qualification process, all applicants must provide a current credit report from each of the three major credit reporting agencies listed below: √Experian √Equifax √TransUnion. Please upload a copy of each credit report in PDF format. Credit reports should be dated within the last 60 days. PLEASE NOTE: Credit verification is required to complete the pre-qualification process.
Drop files here or
Accepted file types: jpg, gif, png, pdf, Max. file size: 25 MB.

    Declaration

    I do hereby represent that all of the above answers are true and complete to the best of my knowledge and belief. I recognize that G.L.O.M. Franchising is not in any way obligated to franchise a store to me because of our execution of this document. I acknowledge that any false statement on this application shall be considered sufficient cause to deny any further consideration or cause revocation of any signed agreement with G.L.O.M. Franchising. I understand that an inquiry regarding my character, general reputation, personal characteristics, financial background, and overall fitness for being a G.L.O.M. Franchising franchisee may be made as a result of this application. In addition, by signing below, I release any and all former and/or present employers, as well as any other personal or business references, from any liability whatsoever in connection with G.L.O.M. Franchising’s attempts to investigate my background and determine my fitness to become a franchisee. I hereby authorize the release of any and all documents, records, and other information pertaining to me to G.L.O.M. Franchising. A copy of this authorization may be used in place of and shall be valid as the original. I understand that this application is considered active for 60 days from the date below. I further understand that G.L.O.M. Franchising reserves the right to reject my application without assigning any reasons whatsoever. I confirm that I will immediately notify G.L.O.M. Franchising in writing of any changes to my personal data or any other information contained in this form. By completing this form, I consent to the collection, use, and disclosure of my personal data for the purposes of evaluating the franchise application, and, if my franchise application is approved, then for the further purposes of administering, supporting, and managing my relationship as a franchisee with G.L.O.M. Franchising.(Required)
    Clear Signature
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