Application for franchise—Automobile sales and service agreement. _________ MOTOR CORPORATION in U.S.A. [Franchisor address] APPLICATION FOR _________ SALES & SERVICE AGREEMENT Date _________
Please indicate if this application is being submitted on a confidential basis. [ ] Yes [ ] No Gentlemen: This application is submitted in conjunction with a specific dealership. Set forth below is the location and any other pertinent data relating thereto: This application is being submitted with no specific dealer point in mind. Indicated below is the size dealership opportunity desired in terms of annual new unit sales potential. ......................................................................................... ............................................................................................ ............. .............
_________Name in full (First, Middle, Last) _________Home Address (Street, City, State, Zip Code) _________Business Address (Street, City, State, Zip Code) _________Home Telephone No. ¦ Business Telephone No. ¦ Date of Birth ¦ Marital Status [ ] Single [ ] Married _________Present State of Health ¦ Date of Last Physical Examination _________Number of Dependent Children ¦ Number of Other Dependents ¦ Other Obligations _______________ Have you ever been employed, in any capacity, by a _________ Dealer? [ ] Yes [ ] No When _________ Dealer's Name ................................................................................................................................................... Dealer's Address ................................................................................................................................................................................ Do you now own, operate, or have a financial interest in or have you previously owned, operated or had a financial interest in any automobile dealership? [ ] Yes [ ] No If yes, please complete information requested below:
MAKE OF CAR OWNED, PERIOD HANDLED MANAGED OR FINANCIAL INTEREST
CITY
REASON FOR TERMINATING
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_________ Outline in chronological order the positions or businesses in which you have participated during the past. (10 years minimum, most recent first.) 1. ...................................... ...................................... ...................................... ..................................... DATES POSITION/BUSINESS NAME OF FIRM TYPE OF BUSINESS ...................................... ...................................... ................................................................................. TELEPHONE SUPERVISOR REASON FOR LEAVING ...................................... ...................................... ...................................... ..................................... DATES POSITION/BUSINESS NAME OF FIRM TYPE OF BUSINESS ...................................... ...................................... ................................................................................. TELEPHONE SUPERVISOR REASON FOR LEAVING ...................................... ...................................... ...................................... ..................................... DATES POSITION/BUSINESS NAME OF FIRM TYPE OF BUSINESS ...................................... ...................................... ................................................................................. TELEPHONE SUPERVISOR REASON FOR LEAVING ...................................... ...................................... ...................................... ..................................... DATES POSITION/BUSINESS NAME OF FIRM TYPE OF BUSINESS ...................................... ...................................... ................................................................................. TELEPHONE SUPERVISOR REASON FOR LEAVING
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_______________ Comments for Clarification: _______________
Were you ever convicted of a crime? [ ] Yes [ ] No If so, explain nature and outcome. Will you actively manage and operate the proposed dealership? [ ] Yes [ ] No If you will not manage and operate, whom do you propose? _______________ His/Her Age _________ Marital Status: [ ] Married [ ] Single Number of Dependents _________ Do you receive income from other sources? [ ] Yes [ ] No If yes, state annual amount and source. _________ Have you ever failed in business, taken bankruptcy or compromised with your creditors? [ ] Yes [ ] No If yes, give pertinent details. _______________ REFERENCES: BANK AND/OR FINANCE COMPANY INDIVIDUAL
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...................................................................................................................................... ...................................................................................................................................... CITY/STATE/ZIP TELEPHONE ...................................................................................................................................... ...................................................................................................................................... CITY/STATE/ZIP TELEPHONE ...................................................................................................................................... ...................................................................................................................................... CITY/STATE/ZIP TELEPHONE ...................................................................................................................................... ...................................................................................................................................... CITY/STATE/ZIP TELEPHONE
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_______________ PERSONAL REFERENCES (Do not list employers, employees, relatives) NAME IN FULL ADDRESS OCCUPATION
1.
................................................................................................................................................... NUMBER OF YEARS .................................................KNOWN _________
TELEPHONE _________ 2.
................................................................................................................................................... NUMBER OF YEARS .................................................KNOWN _________
TELEPHONE _________ 3.
................................................................................................................................................... NUMBER OF YEARS .................................................KNOWN _________
TELEPHONE _________ 4.
................................................................................................................................................... NUMBER OF YEARS .................................................KNOWN _________
TELEPHONE _________
Have you ever been bonded? [ ] Yes [ ] No Name of Bonding Company _______________ Has your bond ever been withdrawn or application rejected? [ ] Yes [ ] No If yes, give particulars. _________ _______________ OTHER INVESTORS If a financial investment will be made in the proposed dealership by another (or others), complete the following: PART OF INVESTMENT AMOUNT INITIAL OWNED BORROWED INVESTMENT
NAME OF INVESTOR(S)
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The proposed dealership will be a [ ] Corporation [ ] Partnership [ ] Sole Proprietorship
Do any of the investors have a financial interest in any other automobile dealership or in an independent Used Car business? [ ] Yes [ ] No If Yes, give individual's name, dealership name and address, lines handled (if known) and percent of interest in each case. NAME LINES HANDLED % OF OWNERSHIP
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Do you have any relatives who, although they will not have an interest in this proposed dealership, own an automobile dealership or have financial interest in one? [ ] Yes [ ] No If yes, please give name and location of dealership and name of relative. _______________ _______________ PERSONAL FINANCIAL STATEMENT & INVESTMENT Set forth below is a true and accurate statement of my personal financial condition as of _________ If currently in business as an automotive dealer, attach most recent statement. ASSETS LIABILITIES
CURRENT ASSETS
CURRENT LIABILITIES Cash $.................................. Accounts Payable .. Notes Payable (Amount Current Receivables .................................... due in one year .. except mortgage on Accounts $.................................. residence) .. Misc. Obligations Notes .................................... (Describe)
$.................................. ..
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.. Prepaid Expenses .................................... .................................... .. .. TOTAL CURRENT ASSETS $.................................. .................................... .................................... .. .. .. TOTAL CURRENT OTHER ASSETS LIABILITIES $ Securities (Describe) .................................... .. Chattel Mortgages $ .................................... .................................... .. .. Real Estate Mortgages .................................... .................................... .. .. Other Obligations (Describe) .................................... .................................... .................................... .. .. .. .................................... $.................................. .................................... .................................... .. .. .. .. FIXED ASSETS Residence .................................... .. Furniture & Personal Goods .................................... .. Other (Describe) .................................... TOTAL $.................................. .. LIABILITIES .. .................................... .................................... NET WORTH $.................................. .. .. .. TOTAL ASSETS $_____ TOTAL $_____ LIABILITIES & NET WORTH
How much money are you prepared to invest in the proposed dealership? $_____ If certain Assets listed above are to be part of original investment, explain how they are to be liquidated and when proceeds will be available. ........................................................................................................................................................................................... .................... _______________ If not, where will investment capital be derived? .......................................................................................................................... _______________
Will any part of your investment be encumbered? [ ] Yes [ ] No If yes, set forth from whom borrowed, terms, conditions and restrictions. _______________ Will the borrowed funds be a liability of the dealership? [ ] Yes [ ] No _______________ PROPOSED BUILDING & FACILITIES (If application is not being submitted in conjunction with a specific point, omit this section) Are facilities adequate? [ ] Yes [ ] No If not, in what respect are they inadequate? _________ _______________ _______________ Would you sign a written agreement to remedy and correct the inadequate facilities? [ ] Yes [ ] No If building(s) is to be rented, what is annual rent? $_____ When will lease expire? _________ Does the lease contain a clause for option to renew? [ ] Yes [ ] No Give particulars or renewal option in lease. .............. _______________ If building(s) is owned what is investment in land and building(s)? $_____ What is amount of mortgage? $_____ _______________ For the purpose of securing credit and other considerations, the undersigned furnishes the above information and Financial Statement which fully and truly sets forth his/her financial condition on the _________ day of _________, 19__. The undersigned acknowledges and agrees: 1. This application form has been supplied to him/her as a convenience only, and _________ Motor Corporation in U.S.A. shall not incur any obligation or liability by receipt of this application. 2. No one other than the President or an authorized Vice President of _________ Motor Corporation in U.S.A. has the authority to approve the undersigned's application for a _________ Sales & Service Agreement. Final approval will be upon the execution of the Sales & Service Agreement by any one of the above named officers. 3. Any misrepresentation or omission, whether intentional or unintentional, in the information supplied by the applicant in this form shall be grounds upon which _________ Motor Corporation in U.S.A. may immediately terminate any Sales & Service Agreement entered into subsequently with the applicant. 4. The applicant for a _________ dealer Sales & Service Agreement authorizes _________ Motor Corporation in U.S.A. to conduct all reasonable inquiries, investigate or verify personal resumes and financial data and other
representations made by or concerning the undersigned. The undersigned being all of the persons involved in the ownership or executive management of the proposed dealership. _________ _________ _________ _________ _________ _________ Signature _________ Witness _________