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Midas Franchise Agreement document sample
Document Sample
Application Form
CONFIDENTIAL
MIDAS AUSTRALIA PTY LTD
PERSONAL DATA SHEET
To Midas Australia Pty Ltd (ABN 24 005 241 798)
l/we wish to initiate enquiry to the Midas Group for a “Midas Car Care” franchise and trade mark agreement.
I/we wish to submit the information listed below specifically for this purpose.
GENERAL DISCLOSURE STATEMENT
The Midas Group collects and uses personal information about you to assist in assessing the suitability of
you as a prospective Midas franchisee and should the application be successful, for the purposes of
preparing the Midas franchise agreement between you as the prospective franchisee and Midas Australia
Pty Ltd (ABN 24 005 241 798)
We may contact referees (if any) supplied in your application and seek to verify the relevant information
detailed in your application or seek further information.
We may disclose personal information about you to:
1. other organisations within the Midas Group; and
2. organisations that we use in the ordinary administration of our business.
If at any time you provide the personal information of another person to us (such as the name and contact
details of referees) then you must first ensure that that person (or their parent or guardian if they are under
18) has read and understood this statement and separately consented to that personal information being
used and disclosed by us for the above purposes.
If you do not provide us with the information required on the relating to your present health status, major
health conditions or criminal record details, we may be unable to process your application.
You may request access to personal information about you held by the Midas Group, or obtain more
information on the Midas Group Privacy Policy, by contacting our Privacy Officer at privacy@midas.com.au.
You may also view our Privacy Policy at www.midas.com.au.
PLEASE ENSURE THE FORM IS COMPLETED IN ITS ENTIRETY. PLEASE ENSURE THAT THE FORM
IS SIGNED ON PAGE (6), IN ADDITION TO SIGNING THE CREDIT APPLICATION ON PAGE 7. YOUR
SPOUSE OR PARTNER IS REQUIRED TO SIGN THE CREDIT APPLICATION WHERE INDICATED.
Please return the completed form to:
Midas Australia Pty Ltd
PO Box 2429 Gladstone Park VIC 3043
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1. PERSONAL
Name in full: _________________________________________________________________________
Surname First Others
Home Address:_________________________________________________________________________
Street Suburb State Post Code
Business Address:_______________________________________________________________________
Street Suburb State Post Code
Telephone Nos: ( ) ___________________ ( )______________________ ( )______________________
Home Business Home/Bus Fax
Age: __________________Date of Birth: ___________________Marital Status: ______________________
Passport No.________________ Country issued: ________ No. of Children: ______Ages:__________
Spouse's Name:___________________________ Preferred Franchise Location:______________________
Other Preferences (in order) ______________________________________________________________
2. EDUCATION & BUSINESS EXPERIENCE
Present Business/Employment Details: ______________________________________________________
Previous Business/Employment Experience: __________________________________________________
Do you have any Automotive experience? Yes / No If Yes, please give details:
______________________________________________________________________________________
Are you a Qualified Mechanic? Yes / No If Yes, please give details:
______________________________________________________________________________________
Have you ever been declared Bankrupt? Yes / No If Yes, please give details:
______________________________________________________________________________________
Have you ever been a Director of a company that has been placed in liquidation, receivership or entered into
any arrangement with creditors? Yes / No If yes, please give details:
________________________________________________________________________________
Please list any Company Directorship you currently hold, or have held in the past 5 years
Company Name Position Registration No Date(s)
______________________________________________________________________________________
2
3. ATTITUDE
A. List three chief reasons you are considering starting a franchise business:
______________________________________________________________________________________
______________________________________________________________________________________
B. Outline any past experience you believe qualifies you to operate a Midas franchise:
______________________________________________________________________________________
______________________________________________________________________________________
C. What are your chief business strengths?
______________________________________________________________________________________
______________________________________________________________________________________
D. What are your chief weaknesses?
______________________________________________________________________________________
______________________________________________________________________________________
E. What is your greatest achievement?
______________________________________________________________________________________
______________________________________________________________________________________
F. What appeals to you about the Midas franchise system and how do you think you can make your
greatest contribution to the Midas franchise system?
______________________________________________________________________________________
______________________________________________________________________________________
G. What are the advantages of a franchised business over a non franchised business?
______________________________________________________________________________________
______________________________________________________________________________________
H. Have you operated a franchise or been employed by a franchise operator previously? Yes / No If Yes
please give details:
______________________________________________________________________________________
______________________________________________________________________________________
I. Do you feel the Midas franchise recruitment process has been handled suitably to this point, and that the
information supplied has been of assistance? Eg Yes / No
Please explain: _________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
3
4. FINANCIAL DATA
Average costs for a new Midas store in Australia is in the range of AUD150,000 to AUD250,000.
What amount of your initial investment will be cash? $________________________________________
Do you have any available borrowing facilities established? Yes / No
If yes, please give details:
______________________________________________________________________________________
If a financial investment is to be made in the proposed Midas franchise by others, complete the following:
Name of investors: ______________________________________________________________________
Amount of initial investment: $ _____________________________________________________________
Part of investment borrowed: $ _____________________________________________________________
All investors are to complete a similar application.
FINANCIAL STATEMENT
(Including spouse if applicable)
Annual Income
The following is for preliminary assessment only (Use nearest $'000)
Salary or Business (Self): $_________________________________
Salary or Business (Spouse. if applicable): $_________________________________
Shares and Bonds: $_________________________________
Real Estate: $_________________________________
Other - State sources_________________ $_________________________________
__________________________________ $_________________________________
__________________________________ $_________________________________
Total Income: $_________________________________
4
FINANCIAL STATEMENT
(include spouse if applicable)
Net Worth
Assets
Real Estate: $________________________
Bank Balance: $________________________
Investments: $________________________
Other Assets (provide details)
______________________________
______________________________
Total Assets: $______________________
Liabilities
Mortgage: $________________________
Other Liabilities (provide details) $________________________
________________________ $________________________
________________________ $________________________
Total Liabilities $________________________
Net Worth
(total assets less total liabilities) $_________________
5
5. DECLARATION
Have you ever been in the employ of Midas Australia Pty Ltd, Midas Car Care (Aust) Pty Ltd, a Midas
Franchisee or any of its affiliates?
Yes / No
If Yes. State where? ______________________ When? _____________________________
Present state of health: ______________________________________________________________
Do you have any major health problems? _______________________________________________
Have you ever been convicted of a crime? Yes / No If yes, give details:
_________________________________________________________________________________
_________________________________________________________________________________
Business References:
Name Address Ph.No. Occupation/Years Known
______________ _______________ ____________ ____________________
______________ _______________ ____________ ____________________
______________ _______________ ____________ ____________________
Personal References:
Name Address Ph.No. Occupation/Years Known
______________ _______________ ____________ ____________________
______________ _______________ ____________ ____________________
______________ _______________ ____________ ____________________
The undersigned acknowledges and agrees:
1. This form has been supplied at the applicant's request and Midas Australia Pty Ltd shall not incur any
obligation or liability by receipt of the form.
2. No person other than the Chief Executive Officer of Midas Australia Pty Ltd has the authority to approve
the undersigned for a “Midas Car Care Centre” franchise and trade mark agreement. Final approval shall
be upon execution of the franchise and trade mark agreement by the above named officer.
3. Any material misrepresentation, whether intentional or unintentional, in information supplied by the
applicant in this form shall be grounds upon which Midas Australia Pty Ltd may immediately terminate
any agreements executed by the undersigned.
Signature: ____________________________ Date: ___________________
Witness: ____________________________ Date: ___________________
6
CREDIT APPLICATION
Please ensure your spouse or partner signs below where indicated, in addition to yourself.
FEDERAL PRIVACY ACT - CONSENT AND ACKNOWLEDGEMENT
WE,………………………………………… and…………………………………………………. of
……….................................................................................. by signing below specifically agree and
acknowledge with the Midas Group as follows:
1. That the Midas Group hereby informs me/us that it may disclose to a credit reporting agency certain
personal information about me/us including: information contained in my/our Personal Data Sheet;
my/our identification; payments which may become more than 60 days overdue; advice that
payments are no longer overdue; a serious credit infringement which the Midas Group believes I/We
have committed; and the discharge of my/our credit facility.
2. That the Midas Group, in assessing my/our application to become a Midas franchisee and any later
assessment of my/our credit standing, may obtain from a credit reporting agency a credit report
containing personal credit information about me/us and any corporation of which I/we are now or
may become at any time in the future office holder/s and/or shareholders and a credit report
containing information about my/our and any corporation of which I/we are now or may become at
any time in the future office holder/s and/or shareholders commercial and consumer activities or
commercial and consumer credit worthiness.
3. That the Midas Group may give to and obtain from any credit provider(s) that may be named in a
credit report held by a credit reporting agency information about my/our personal, commercial and
consumer credit history or credit capacity for the particular purpose for which the information is
required PROVIDED THAT where information is requested from the Midas Group, the Midas Group
shall not give such information without first notifying us that such information has been requested
and the identity of the Party making the request.
4. That the Midas Group may give a credit report about me/us to any tribunal or the Banking
Ombudsman or an authorised person, including my/our agent, accountant or solicitor PROVIDED
THAT the Midas Group shall not give such credit report without first notifying us that such report has
been requested and the identity of the party making the request.
5. If the Midas Group approves my/our application to become a Midas franchisee my/our above
Consent and Acknowledgment will remain in force for the duration of the term of the Franchise
Agreement.
…………………………………/…/… …………………………………/…/…
Signature Date Signature Date
7
CREDIT APPLICATION DISCLOSURE STATEMENT
The Midas Group collects and uses personal information about you to assess your credit worthiness and to
obtain a credit report from credit reporting agencies and/or other credit providers for the purpose of
assessing your application to purchase a Midas franchise. We may disclose personal information about you
to:
1. those organisations described in this Credit Application Form;
2. organisations that we use in the ordinary administration of our business; or
3. as otherwise authorised by you.
You may request access to personal information about you held by the Midas Group, or obtain more
information on the Midas Group Privacy Policy, by contacting our Privacy Officer at privacy@midas.com.au.
You may also view our Privacy Policy at www.midas.com.au.
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