* Your Full Name:		* Home Phone:
* Street Address:		* Business Phone:
* City:		* Cell Phone:
* State / Zip: /		Email:
Best Day / Time to Call:		Fax:

What Location(s) are you interested in?

How much time can you devote to this business?

What interested you most in an Average Joe's Franchise?

How did you hear about Average Joe's Gym? Postcard / Mailing Newspaper Referred by Friend Radio / TV Ad

Will Average Joe's Gym be your only income source? Yes No

PREVIOUS EXPERIENCE
(List your last occupations)

Mo./Yr.		Employer Name and Address	Type of Business	Salary	Position	Reason for Leaving
From:				select -$20K $20k - $40k $40k - $60k $60k - $80k $80k - $100k +$100k
To:
Mo./Yr.		Employer Name and Address	Type of Business	Salary	Position	Reason for Leaving
From:				select -$20K $20k - $40k $40k - $60k $60k - $80k $80k - $100k +$100k
To:

REFERENCES
(List below the names of three persons not related to you whom you have known at least one year.)

Name	Phone Number	Position	Years Aquainted

Will you operate as a:	select one Sole Proprietorship Partnership Corporation LLC Not Known
Dependants:
Education Level Attained :	select one Some H.S. High School Graduate Some College College Graduate Advanced Degree		Name of Last School:

PERSONAL FINANACIAL STATEMENT AS OF (date:)
What is your approximate net worth? (Total assets minus total liabilities): select one Under $100,000 $100,000 - $300,000 $300,000 - $500,000 Over $500,000

Average Joe's Gym, Inc. requirements:
The information enclosed in this document is only to inform and familiarize you with some of the criteria required to qualify you as a prospective franchisee for an Average Joe's Gym Franchise. This document does not give any territory rights discussed or otherwise. An Operating partner must have the financial capability to forgo the process of this business venture within the specified time-frames given by Average Joe's Gym. The Operator/Operating Partner must live in a local vicinity of the franchised territory and be involved in daily operation of the franchise.

In order for Average Joe's Gym to begin the process of franchise approval all information required must be completed and signed by any partners or applicants involved.

1. What do you want to achieve with an Average Joe's Gym Franchise?

2. If Partnership or formed Corporation please list the ownership interest of each partner

3. List other qualifications you would like us to know

4. Will any partner, sole proprietor, corporation, L.L.C. be involved with a competing business similar to Average Joe's Gym?

Confidentiality and Non-Disclosure Agreement
Applicant agrees to not disclose directly or indirectly any such information without Average Joe’s Gym otherwise known as “we” or “Company” prior written consent, nor shall Applicant use any such Evaluation Material by you, your employees, affiliates, or your representatives (collectively, your “representatives”) in any way detrimental to the Company of for the benefit of any third party. As a condition to furnishing you with this information, you agree that this information and any other information which the Company furnishes to you or your representatives or which you or your representatives obtain through this access (collectively, the “Evaluation Material”) will be kept confidential. The Evaluation Material will be treated as belonging to the Company, and shall not, without our prior written consent, be disclosed in any manner, in whole or in part, to anyone who is not one of your affiliates or representatives and does not have a need to know it to help in the Acquisition. The Evaluation Material shall not be used other than for the purpose of the Acquisition.

You agree that you will not, and your representatives will not, disclose to anyone who is not a direct participant in the possible Acquisition, either the fact that negotiations are taking place or any of the terms, conditions, or other facts with respect to a possible transaction.

If our negotiations with you are terminated for any reason, or if the Acquisition is not consummated promptly, you agree to return to the Company all Evaluation Material and all copies, summaries, and notes of the contents or parts of this material (regardless of who made them), without retaining any copies of any of this material. If applicant or affiliates destroys Evaluation Material sent by Company, Company will need a written letter with such statement sent from Applicant and Affiliates.

Breach
No failure or delay by us in exercising any right, in whole or in part, shall operate as a waiver of any other right. It is further understood and agreed that money damages may not be a sufficient remedy for any breach of this Agreement by you; and that the Company shall also be entitled to specific performance as a remedy for any such breach. These remedies shall not be deemed to be the exclusive remedies for your breach of this Agreement, but shall be in addition to all other remedies available at law or equity to the Company.

If you are in agreement with this, please agree to the terms of the Company below. It will then constitute our Agreement with respect to its subject matter.

Have you or any of your affiliates ever filed bankruptcy? No, or Yes. If so,when?

Have you or any of your affiliates ever been convicted of a felony? No, or Yes.

Applicant understands that our Company reserves the rights to look into character background, financial status and but, not limited to credit history.

Each Party involved in this application process by agreeing below acknowledges and understands that the preceding statements/answers in this document are factual and true and shall constitute an ongoing representation. The information you provide herein may serve as a basis for franchise approval, denial or termination of an already granted franchise.

I accept the above terms. Yes, or No.