Franchise Request Form

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Location of interest (Alberta, Canada only)

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Email *

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Day Time Phone Number *

Mobile Number *

Why does LUBE FX interest you? *

Do you currently own a business? *

When would you like to start your business? *

Where would you like to locate your business? *

What is your employment status? *

Employed
Self Employed
Unemployed
Retitred

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Company/ Employer *

Province/ State *

Nature of Business *

From / To *

Highest Level of Education Completed: *

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School Attended *

City, State , Country *

Year Completed *

Program / Degree *

I Understand

Applicant declares that all the information provided herein is to the best of their knowledge true, complete and correct.

I understand that cost of opening Lubefx franchise store is approximately $392,000- $657,000. Cash equity requirement is approximately $156,800 - $260,000 subject to any additional financial requirements due upon the landlord building the shell and or converting existing automotive stores. Thank you for taking the time to fill out this form. LUBE FX will only use this form to help evaluate your qualifications as a prospective franchisee. This form places no obligation on either party. Upon receipt, LUBE FX will send you more detailed information on becoming an owner. ALL INFORMATION IS FOR INTERNAL USE AND WILL BE HELD IN COMPLETE CONFIDENCE

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Have you ever filed for Bankruptcy? *

If yes, please identify discharge date: *

Have you ever been convicted of an indictable or hybrid offense? *

Are you or any one in your immediate family currently under any form of non-competition agreement that limits your right to operate any business? *

If yes, list name of company or employer and relationship: *

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Company/ employer *

Relationship *

Will you have Partners? *

If yes, please fill out the following sections. Otherwise skip this section. Please note that we require partners to fill out their own franchisee application in addition to this section. *

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Partners Name *

% of Ownership *

Active / Silent *

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Assets

Cash: $ *

Investments / RRSPs: $ *

Automobiles: $ *

Real Estate Market Value: $ *

Other: $ *

Total Assets: $ *

Liabilities

Annual Household Expenses: $ *

Credit Cards: $ *

Loans Payable: $ *

Real Estate Mortgages: $ *

Other: $ *

Total Liabilities: $ *

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Applicants Signature

Date *

RETURN THIS FORM TO: Franchising@LubeFx.com

Comment or Message

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