potential franchisee questionnaire

Please complete and submit the form below. Before you begin, however, we recommend that you first review the questions, so you can prepare appropriately. (You cannot save your progress.)

If you have any questions or concerns, please call 800.704.5004 or email opportunities@anytimefitness.com

Personal Information

* First Name:
* Last Name:
Date:
* Address 1:
Address 2:
* City:
* State:
* Zip Code:
* Cell Phone:
Home Phone:
Work Phone:
Contact at Work:
* Email:
Marital Status:
Spouse First Name:
Spouse Last Name:
If you are considering a partnership for this franchise, please complete the following information about your prospective partner:
First Name:
Last Name:
Address 1:
Address 2:
City:
State:
Zip Code:
Cell Phone:
Home Phone:
Work Phone:
Contact at Work:
Email:
Marital Status:
Spouse First Name:
Spouse Last Name:



Current Employment

Company Name:
Title:
Start Date:
Address 1:
Address 2:
City:
State:
Zip Code:



Fitness Industry Experience

If applicable, please describe any previous fitness industry experience:


As you consider franchising opportunities with Anytime Fitness, please rank what’s most important to you, with 1 being your highest priority.

Other:

Please also rank your level of concern in the categories below, with 1 being your biggest concern.

Other:



Club Operations

* Do you plan on working full time at your
Anytime Fitness club?:

* If working with a partner, do they plan on working
full time at the club?:




Location / Demographics (First Choice)

* Proposed City:
* State:
* Population:
* Nearby Cities:



Location / Demographics (Second Choice)

Proposed City:
State:
Population:
Nearby Cities:



Assets & Liabilities

Assets Current Value
Cash on Hand (checking/savings) ($)
401K/IRA/Profit Sharing Plan ($)
Notes/Accounts Receivable (Schd. 5) ($)
Marketable Securities (Schd. 2) ($)
Life Insurance
(Cash value only - Schd. 4)
($)
Homestead Owned (Schd. 1) ($)
Other Real Estate (Schd. 1) ($)
Automobile(s) ($)
Equity Value in Existing Business (Schd. 3) ($)
Other Personal Property ($)
Other Assets (specify separately) ($)
Total Assets ($)
Liabilities Balance Owed
Mortgage on Homestead (Schd. 1) ($)
Home Equity or Line of Credit ($)
Auto Loans ($)
Credit Cards (balance of all) ($)
Other Loans (property/personal) ($)
Accounts Payable (Schd. 6) ($)
All Other Liabilities ($)
Alimony/Child Support (Balance) ($)
Taxes Owed ($)
Total Liabilities ($)
Net Worth (assets minus liabilities) ($)
Total Liabilities and Net Worth ($)



Income Applicant co-Applicant
Salary/Wages (C) ($) ($)
Commission/Bonuses ($) ($)
Rental Income ($) ($)
Investment Income ($) ($)
Business Income ($) ($)
Other Income ($) ($)
Other Income ($) ($)
Total Income ($) ($)
Monthly Liabilities Applicant co-Applicant
Mortgage or Rent
(homestead)
($) ($)
Mortgage
(Other real Estate)
($) ($)
Insurance/Property
Taxes
($) ($)
Auto Loan/Lease
Payment
($) ($)
Credit Card Payments ($) ($)
Alimony/Child Support ($) ($)
Liens/Judgments ($) ($)
Other Debt ($) ($)
Total Liabilities ($) ($)



Real Estate Owned | Schedule 1

Type of Property Address of Property Purch. Date Original Cost Current Mkt Value Mortgage Balance Monthly Payment



Marketable Securities | Schedule 2

Name of Security Number of Shares Purchase Cost Date Purchased Current Market Value



Equity in Existing Business(es) | Schedule 3

Name of Business Ownership % Date Ownership Acquired Equity Value of Ownership



Life Insurance | Schedule 4

Insurance Company Face Value Cash Surrender Value Beneficiary



Notes/Accounts Receivable | Schedule 5

Debtor Description of Receivables Repayment Terms Balance Due
Per
Per
Per



Notes/Accounts Payable | Schedule 6

Payee Description of Liability Repayment Terms Unpaid Balance
Per
Per
Per



Other

1. Have you ever filed for bankruptcy?

If yes, please explain:
2. Are you currently or have you been the defendant in any suits or legal actions?

If yes, please explain:
3. Has a tax lien ever been filed against you, your personal property, a business in which you have held ownership, or any business property in which you have held ownership?

If yes, please explain:



I authorize Anytime Fitness, LLC. and its Assigns to make inquiries as necessary to verify the accuracy of the statements made and to determine my creditworthiness. I certify the above and the statements contained in the attachments are true and accurate as of the stated dates. These statements are made for the purpose of either obtaining commercial credit or guaranteeing commercial credit. I understand FALSE statements may result in forfeiture of benefits and possible prosecution by the U.S. Attorney General (Reference 18 U.S.C. 1001). Anytime Fitness, LLC may share your personal financial statement with its affiliates, if necessary.