Online Franchise Application
Online Franchise Application
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*
are mandatory.
Personal Information
*
First Name :
*
Last Name :
Date :
*
Email :
Gender :
Male
Female
US Citizen :
Yes
No
Present Address :
Social Security # :
Home Phone :
Home Phone Extension :
Work Phone :
Work Phone Extension :
*
City :
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Country :
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Afghanistan
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Netherlands
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New Caledonia
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Nicaragua
Niger
Nigeria
North Cyprus
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Pierre and Miquelon
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
Spain
Sri Lanka
St Lucia
St. Kitts & Nevis
St. Vincent & the Grenadines
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos
Tuvalu
USA
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States Virgin Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
West Bank and Gaza Strip
Western Sahara
Yemen
Zaire
Zambia
Zimbabwe
*
State / Province :
Select State
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Alaska
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California
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Connecticut
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District of Columbia
Florida
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Hawaii
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Kentucky
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Maine
Maryland
Massachusetts
Michigan
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New Jersey
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North Carolina
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Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip / Postal Code :
How long at this address? (Yrs) :
Previous Address :
City :
Country :
Select Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua & Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Caribbean
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote dIvoire (Ivory Coast)
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Federated States of Micronesia
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Gaza Strip and West Bank
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
North Cyprus
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Pierre and Miquelon
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
Spain
Sri Lanka
St Lucia
St. Kitts & Nevis
St. Vincent & the Grenadines
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos
Tuvalu
USA
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States Virgin Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
West Bank and Gaza Strip
Western Sahara
Yemen
Zaire
Zambia
Zimbabwe
State / Province :
Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip / Postal Code :
Birth Date :
Select Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Select Date
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
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30
31
Best Time To Call :
00.00
01.00
02.00
03.00
04.00
05.00
06.00
07.00
08.00
09.00
10.00
11.00
12.00
13.00
14.00
15.00
16.00
17.00
18.00
19.00
20.00
21.00
22.00
23.00
Home Ownership :
Own
Renting
Marital Status :
Single
Married
Spouse Name :
Spouse Social Security # :
Spouse US Citizen :
Yes
No
Spouse Birth Date :
Select Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Select Date
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
US Military Veteran ? :
Yes
No
Spouse Email :
Spouse Phone :
Assets and Liabilities
ASSETS
LIABILITIES
Cash on Hand & in Banks ($) :
Mortgages ($) :
Marketable Securities ($) :
Accounts Payable ($) :
Accounts / Notes Receivable ($) :
Notes Payable ($) :
Retirement Plans ($) :
Loans On Life Insurance ($) :
Real Estate ($) :
Credit Cards (total balance) ($) :
Personal Property ($) :
Unpaid Taxes ($) :
Business Holdings ($) :
Other Liabilities ($) :
Other Assets ($) :
Description :
Description :
Total Liabilities ($) :
Total Assets ($) :
Total Net Worth ($) :
Real Estate 1
Address :
Date Purchased :
Original Cost :
Text
Mortgage Balance :
Present Value :
Real Estate 2
Address :
Date Purchased :
Original Cost :
Present Value :
Mortgage Balance :
Real Estate 3
Address :
Date Purchased :
Original Cost :
Present Value :
Mortgage Balance :
Annual Sources of Income
Salary ($) :
Investment ($) :
Real Estate Income ($) :
Other ($) :
Description :
Total ($) :
Total Contingent Liabilities
Loan Co-signature :
Legal Judgement :
Income Taxes :
Other Special Debt :
Total :
Specific Data
If yes, please explain:
*
What are the responsibilities of the Franchisor? :
*
What are the responsibilities of the Franchisee? :
Why do you think this franchise will enable you to reach your personal goals? :
When would you be ready to invest in your franchise if you were approved ? :
What skills/experience do you have that will help you be successful in this business ? :
Have you been approved for financing? :
Yes
No
Who will be responsible for the daily operation of your store? :
Amount of cash available for investment? :
Do you have any contingent liabilities for guarantees, endorsements, leases etc ? :
Yes
No
Amount Approved ($) :
Would this business be your sole income source? :
Yes
No
Have you ever been convicted of a felony? :
Yes
No
Are you now, or have you ever been party to any lawsuit - either as defendant or plaintiff ? :
Yes
No
Have you ever been convicted of any offense (including misdemeanors for which you have fined $ 200 or more) ? :
Yes
No
Date Filed :
If so, explain :
Have you ever filed for bankruptcy? :
Yes
No
Date Discharged :
Area / Location Preferences
Preference 1 :
Preference 2 :
Preference 3 :
Please list the three main questions you have about this business opportunity
Question1 :
Question2 :
Question3 :
Captcha
( Enter the text you see in the image below )
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Disclaimer
I hereby certify that all information herein contained is true and correct, to the best of my knowledge and understanding, and that any substantial error in fact may be reason for future recall of a Grease Monkey or SpeeDee Oil Change & Auto Service franchise, if awarded, as well as possible legal action for damage or inconvenience sustained as the result of said error in fact. This application does not obligate either party in any manner. I authorize Grease Monkey Franchising, LLC and SpeeDee Worldwide, LLC to perform whatever creditor or background check it deems necessary in reviewing my application.
*
I Agree
Signature :