Request Information - Gecko Franchises

[ A ]

PERSONAL INFORMATION
Name
First Name
Last Name
Current Residence
Street Address City State ZIP Code
Do you Own or Rent?
- Own
- Rent
How long at Current Residence?
Previous Address
Street Address City State ZIP Code
How may we reach you?
Home Phone
Work Phone
Cell Phone
Best time of day to call?
Email Address
More about you...
Date of Birth
Marital Status
Number of Dependants
If married:
Spouse's First Name
Spouse's Last Name
Occupation
Will spouse be active in business?
- Yes
- No
How long married?
Number of Children
Ages?
Please explain any physical limitations or conditions which may preclude certain types of activities
Enter explanation here...
Citizenship
Are you a U.S. Citizen?
- Yes
- No
If not, of what country?
Country

[ C ]

EMPLOYMENT PROFILE
- List your three most recent positions, with your current positions first.

- Put an asterisk (*) next to any company names you do not want us to contact.

- Indicate "A" for Applicant, "S" for Spouse.
Employment 1
1
- Applicant
- Spouse
Employer
City/State
Position/Title
From
To
Annual Income
Employment 2
2
- Applicant
- Spouse
Employer
City/State
Position/Title
From
To
Annual Income
Employment 3
3
- Applicant
- Spouse
Employer
City/State
Position/Title
From
To
Annual Income

Gecko Hospitality Request For Consideration Form

Step 1 of 7

[ A ]

PERSONAL INFORMATION

Name

Current Residence

Do you Own or Rent?

How long at Current Residence?

Previous Address

How may we reach you?

More about you...

If married:

Please explain any physical limitations or conditions which may preclude certain types of activities

Citizenship

If not, of what country?

[ B ]

EDUCATION

High School

College or University

Graduate School

Please list any addition Licenses or Certifications obtained...

Are there any other Special Skills or Training you wish to share with us?

[ C ]

EMPLOYMENT PROFILE

- List your three most recent positions, with your current positions first.

- Put an asterisk (*) next to any company names you do not want us to contact.

- Indicate "A" for Applicant, "S" for Spouse.

Employment 1

1

Employment 2

2

Employment 3

3

[ D ]

GENERAL INFORMATION

What are your special interests or hobbies?

How long have you considered owning your own business, and why?

Why are you interested in owning a Gecko Hospitality franchise?

Briefly describe what you view as the qualifications, traits, and skills you have that would enable you to successfully own and operate a Gecko Hospitality franchise.

What career and/or financial goals have you set for yourself and your family?

Will the business be owned and operated by you alone, or with one or more business partners? Please explain.

Will you be responsible for the day-to-day operations of the business? If not, who will?

How will you finance any additional capital needs?

What area or territory are you applying for?

Would you consider any other areas? If so, where?

How soon could you be ready to open a Gecko Hospitality unit?

How would you describe your current interest level in owning a Gecko Hospitality Franchise?

[ E ]

REFERENCES

- Please list three Professional and Character References.

- Do not list former employers or relatives.

Employment 1

1

Employment 2

2

Employment 3

3

- Please list three Bank or Other Financial References.

- Do not list former employers or relatives.

1

1

2

2

3

3

Have you ever been refused a bond?

Are you a defendant in any legal action?

Have you ever had any judgments against you?

Have you ever been convicted of a felony?

Have you or your spouse ever declared bankruptcy?

[ F ]

CONFIDENTIAL FINANCIAL STATEMENT

ASSETS

Other Assets - Itemize:

TOTAL ASSETS:

LIABILITIES

Other Debts - Itemize:

TOTAL LIABILITIES

NET WORTH:

TOTAL LIABILITIES & NET WORTH: