Any partners, shareholders or members of a partnership, corporation or limited liability company must also complete a copy of this application and provide the financial information. If applying as a corporation or limited liability company, please provide the financial statement for the corporation or limited liability company at the end of the last fiscal year and profit and loss statement from the end of the last fiscal year to the date of application, in compliance with general accepted accounting principals.

By submitting this form , I certify all information provided in this application, including financial data is correct.  

By signing this application I authorize investigation, including preparation of credit reports, of all statements contained herein, and the financial information disclosed herein, and releases all parties from any liability for any damage that may result from this investigation.  Application is valid in its original, faxed or copied form.

We will use the information you have provided us to assess your potential to become a qualified franchisee. We do not guarantee or warrant that you will be able to obtain financing for your business if you are approved as a Mr. Goodcents Franchise Systems, Inc. franchisee.

Thank you for completing this confidential application.

This is not a commitment by you, nor by Mr. Goodcents® Franchise Systems, Inc.  

I authorize Mr. Goodcents® Franchise Systems, Inc. and/or the agency of their choice to collect information pertaining to litigation history, criminal convictions, personal references, credit reports, and any other reports needed in completing a background investigation check. I further release any and all parties from any claims, damages, losses, liabilities, costs and expenses, or any other charge or complaint filed with any agency, court or administrative body arising from the retrieving, reporting, and use of this information.