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THE FOLLOWING CONFIDENTIAL AND SECURE INFORMATION IS THE BASIS FOR REVIEW BY GOLF ETC. OF AMERICA INC. THE COMPLETION OF THIS DATA DOES NOT OBLIGATE GOLF ETC. OF AMERICA INC. OR ANY OF ITS OFFICERS, DIRECTORS, EMPLOYEES OR AGENTS IN ANY WAY TO ACCEPT YOUR APPLICATION FOR A GOLF ETC FRANCHISE. NO INFORMATION GIVEN HEREIN WILL BE DISCLOSED TO THIRD PARTIES EXCEPT AS REQUIRED BY APPLICABLE LAW, IF ANY.

ALL FIELDS WITH * ARE REQUIRED


* First Name
* Last Name
* SS Number
* Address
Address 2
* City
*State/Province
* ZIP/Postal Code
* Country
(If International, please include Country Code.)
* Home Phone
* Business Phone
* Cell Phone
* Email
* Age
* Marital Status
* Number of Dependants
* Are You A US Citizen
 Yes No
* Have you ever been
convictied of a felony?
 Yes No
* Have you ever filed
bankruptcy?
 Yes No
 
* Present Employer
* In business for self?
 Yes No
 
* Positions held during the past five years:
* U.S. Military or Naval Service:
Rank:
* How Long at Present Address:
* Area:
* Plans to Relocate?:
 Yes No
* Own Home:
 Yes No
* Mortgage Payments:
* Name of Bank where Accounts Presently Held:
* Checking Savings Both
 
* Approximate Financial Net Worth: $
* Cash Available to Purchase Franchise: $
* Amount to be Borrowed: $
* Available When:
* Give Name, Address, Telephone Number of two Character References: (not present employer)
* Name 1:
* Address 1:
* Phone Number 1:
* Name 2:
* Address 2:
* Phone Number 2:
NO DETAILS SHALL BE GIVEN TO CHARACTER REFERENCES PERTAINING TO INQUIRY. NO CONTACT WILL BE MADE WITH PRESENT EMPLOYER AT ANY TIME.
* Give Name of Two Credit References:
* Credit Reference 1:
* Credit Reference 2:
I AUTHORIZE GOLF ETC. OF AMERICA, INC. TO CHECK THE ABOVE PROFESSIONAL REFERENCES AND CONDUCT A CREDIT CHECK. A FINANCIAL STATEMENT WILL BE REQUIRED TO COMPLETE YOUR APPLICATION.

THE ABOVE INFORMATION IS CORRECT AND ACCURATE.

ACCORDING TO THE LETTER OF INTENT, ANY MISREPRESENTATION OF INFORMATION MAY AFFECT YOUR ABILITY TO OBTAIN ANY TERRITORY DEPOSIT REFUND.
     
* APPLICANTS SIGNATURE

(by checking this box you agree that it will be as if you were to sign the actual document)
   
   
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