FRANCHISE

GODDARDSYSTEMS,ING,
1016 WestNinthAvenue . Kingof Prussia,PA 19406
610-265-8510. 8OO-272-49O1 . Fax:610-265-6931

FranchiseAssociation
Membel International
 FRANCHISE
APPLICATION
A complete investigalive background report may b€ procured in connection with your application.
In the €vent such an investigative consumer report is procurcd, upon your written request of this companyr reoeived within a
r€asonable period of time trom the date of this application, you will be provided a complete and accurate disclosure of the
natuneand scope of the investigation requested,

Appliqant:
(SocialSecurityNumber)

Spouse:
Namein Full: (First) (trliddle) (Last) (SocialSecudty
Number)

Hom€Addr€ss;(Street) (C'ly) (State) (County) (zipCode)

HomeTelephone
Number EmailAddress MadtalSlatus No.of Dependerds

PERSONALDATA(Applicanq
Dale of Bidh: Ar€youa U,S,Citizen? D Yes tr No
lf nota U.S.Ciiizen,do youhavepermanent resident/greencad status? tr Yes tr No
be advised(natwe mayrequestto seeWur grcencad or atherdocum$tationalidencingWW immigrationstatus.)
(Pfease
Haveyoueverlivedoutside of theUniledStates(evenif youarea U.S.Cilizen)? trYes tr No
lf yes,addr$sesandcorr€sponding dates:
Dates StreetAddress Citv CountrY

l.lameandAddressot Employer:

PositionDesc.iption: Bus.Telephone
Number:
Annuailncome: Frombusinessconnectionor practice
Frombondsandsbcks
Fromreal esl,ate

(Lasttwo positionsprior to above)

BUSINESSEXPERIENCE
Fom To Firm Name and Address Position Annuallncomo

DetailedDescription
of BusinessExperience:

RECORDOF EDUCATPN
Couragof Yeers Dkl You De$€e
Type School Sludy Ailended Giaduate? Recei!,€d
Name From
HighSchool
Cily & Stat6 To
Narne From
College Cily& Staie
Name From
Other Cily & State To

MILITARYSERVICERECORD
Didyouserveinlhe U.S.tumedForces? trYes trNo f Yes,WhatBranch?
Datesof SeMce; to Typeof Dischargo:
FINANCIALBACKGRoUND(Applicant& spouse)
PersonalBank Accounts Bugine6sBank Accounts

Nameof Bank Nameol Bank

Address

Nameol Bank Nameof Bank

Addless Address
Financial Statement
ASSETS LIABIL]TIES

Cash(CheckingAccounts) to Banks- Unsecured

NotesPayable
Cash (SavingsAccounts) NotesPayableto Banks- Secured

RealEstate- Rssidence(Cun€ntValue) AccountsPayable

Real Estate - Investm€nt(Cunent Value) RealEstateMortgagesPayable- Residence

401K&IFA)
Stocks, Bonds & SecuritiesGxdudins RealEstateMortgagesPayable- lnvestment

401K BrokersMarginAccounts
IRA OtherLiabilities(ltemize)

TotalAssets Total Liabilifes

Total Assets
(Less) Total Liabilities

= Net Worth
Real EstaleHoldings(lncludingHomel Date Market CurEnt Mortgage
Itescriotionof ProDertvandlmorovements Title In l'lameOf Acqui|€d Cost Value Balance

MISCELLANEOUS Applicani Spouse

Are thereany unsatistiedjudgmentsor legalactionspendingagainstyou? trYes trNo tl Yes tr No
Haveyou pledged,assigned,hypothecatedor transferredtitle to any ol the
assets listed in the personal statement? nYes trNo tr Yes tr No
Have you ever been convicted of a telony or misdemeanorother than minor traffic violations? trYes trNo tr Ye9 tr No
Ar€ anyfelonyor misdem€anorchargespendingagainstyou? tr Yes tr No tr Yes n No
Haveyou everbeen bonded? tr Yes tr No trYes trNo
It bonded,whichjobs
Haveyouevergonethroughbankruptcy,or madea generalassignment? tr Yes t r N o E Yes trNo
Doyouhaveanycontingent
liabilities guarantor,
asco-maker, lesse6,mortgagee,
on contraclsor lor tax claims? tr Yes t r N o trYes trNo
lf you haveanswered'"(es" to any of theseabove questions,pleaseexplain:
PERSONALDATA{Spouse)
Dateof Birth: Areyoua U.S.Cilizen? tr Yes tr No
doyouhayepermanent
lf nola U.S.Cilizen, residenvgreencardstatus? nYes tr No
(Pleasebe advisedthatwa mayrcquestto $eeWur greencardor otherdocumentatonevidencing you immigrationstatus.)
Haveyoueverlivedoutsideof th€ UnitedStates(evenifyouare a U.S.Citizen)? tr Yes tr No
lf yes,addresse$ andcorresponding
dates:
Dates Stre€lAddresg Citv Courirv

NamsandAddress
of Employer;

Position
Description; Bus.T€l€phone
Number:
Annuallncome: F r o mb u s i n e sc so n n e c l ioornp r a c t i c e ...........,.., $
F r o mb o n d as n ds t o c k a. . . . . . . . .....,... $
F r o mr e a l e s b t e ..... ..... ... $
OtherIncome- Pleasestate sourca. . . . . ,,....,...... $

(Lasttwo positionsprior to above)

BUSINESSEXPERIENCE
From To Fi]m Namo and Address Position Annuallncome

DetailedDescription
of BusinessExperience:

RECORDOF EDUCATION
Type Cou,se of Ye€la Did You D€grre
School Study Altended Graduate? Recehred
Name From
HighSchool
Cily & Slate To
Name From
College City & Shte to
Name Frcm
Other Oty & State TO

MILITARYSERVICERECORD
Didyouservein theU.S.ArmddForces? tr yes tr No It Yes,WhatBlanch?
Datesof Serv{c€: to Typeof Discharge:

I understand thatthisapplication
is nota contractanddoesnotcreateanyobligations on the partof GoddardSystems,Inc.
or mysell.Employers namedby me in thisapplicationwill not be contactedby GoddardSystems,Inc. untilsuchtime as a
contractis executedbetweenGoddardSystems,Inc.and me.

Applicant'sSignature Spouse'sSr?nature Date

THISAPPLICATION
DOESNOTOBLIGATEEITHERPARTYIN ANY MANNER,