Franchise Application

Detailed Personal Application

Personal Details
First Name*
Last Name*
Email*
Cell Phone*
Birth date*
MM slash DD slash YYYY
Social Security Number
Home Ownership
Driver License Number
US Citizen?*
- Yes
- No
Do you have an appropriate work visa?
- Yes
- No
Spouse/Partner
Spouse/Partner Name:
Spouse Birth Date
MM slash DD slash YYYY
Spouse Email Address
Spouse Primary Phone
Current Address
Current Address*
Street Address Address Line 2 City State ZIP Code
How many years at this address?
Previous Address
Previous Address
Street Address Address Line 2 City State ZIP Code
Current Employer
Employer Name
Number of Years At Employer
Title
Work Address
Background Details
Have you ever been convicted or plead guilty or no consent to a felony?*
- Yes
- No
Are you currently partly to any legal action*
- Yes
- No
Do you consent to a Background & Credit Check?*
- Yes
- No
Financials
Annual Sources of Income
Salary
Real Estate Income
Investment
Other
Assets
Basic financial asset information
Cash in Checking*
Cash in Savings*
Marketable Securities*
Accounts / Notes Receivable*
Retirement Accounts*
Personal Property*
Business Holdings*
Life Insurance*
Other Assets*
Addtional Comments or Other Assets*
Liabilities
Basic liability information
Mortagages*
Accounts Payable*
Notes Payable*
Loans On Life Insurance*
Credit Cards Total Balance*
Unpaid Taxes*
Other Liabilities*
Additional Comments or other Liabilities*
Total Assets*
Total Liabilities*
Total Net Worth*
Upload PDF Bank statements & Proof Of Identification*
Drop files here or

Accepted file types: pdf, Max. file size: 256 MB, Max. files: 4.
Maximum of 4 Files -- PDF Only
Real Estate
Basic Real Estate information
Real Estate Address 1
Real Estate Date Purchased 1
Real Estate Present Value 1
Real Estate Original Cost 1
Real Estate Mortage Balance 1
Real Estate Address 2
Real Estate Date Purchased 2
Real Estate Present Value 2
Real Estate Original Cost 2
Real Estate Mortage Balance 2
Real Estate Address 3
Real Estate Date Purchased 3
Real Estate Present Value 3
Real Estate Original Cost 3
Real Estate Mortage Balance 3
Background and Credit Check Consent

I understand that as part of the franchise purchase process, Image One Facility Solutions, Inc. (Image One) will make investigative inquiries on my background. The Fair Credit Reporting Act as amended by the Consumer Reporting Reform Act of 1996 requires that we advise you that for purposes of purchase a Consumer Report may be made which may include information about your credit standing and capacity, character, reputation, personal traits, mode of living and other pertinent qualities for franchise ownership purposes including reasons for termination of past employment. Upon written request, information as to the nature and scope of the report will be provided (if one is made) if franchise award has been denied due to information obtained therein. I hereby authorize Image One to conduct background investigations including but not limited to a National Cross Reference of all 50 states showing actual past residences, obtaining a consumer credit report and any other information regarding my driving history and records, criminal history, and credit standing. This release is executed with full knowledge and understanding that the information is for the official use of Image One. A photocopy of this authorization can be accepted with the same authority as the original. If a franchise is awarded, this authorization shall remain on file and shall serve as ongoing authorization for Image One to procure consumer reports at any time during the term of my franchise agreement.
I Give My Consent
I agree to receive SMS messages & emails
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