Your Personal Information Where did you hear about the Beleaf franchise ? * Google Franchise Direct Expo LinkedIn Facebook Recommendation from a friend Visit to the Juice Bar First Name * Last Name * Citizen Of * Permanent Resident of * Date of Birth * Tax ID/National ID/SSN * Optional for additional information purposes but required to begin the process of the purchase and transfer of an existing location. Also note: it will be required prior to the purchase of a new franchise.
Gender * Female Male Are you of legal age * Yes No Have you ever been associated directly or indirectly with terrorist activities ? * Yes No Has a judgment/lien/bankruptcy been filed against you or have you been involved in any litigation proceeding within the last 5 years? * Yes No (If yes, you will need to provide the following for each judgment/lien/bankruptcy proceeding: names of the parties involved, date filed, court where filed and nature of the proceeding.)
Telephone (Home) * Mobile * Residence Address * City * Zip/Postal Code * Country * State/Province * Business Email Address * The email address you provide will be considered a business email address to be used by the Franchisor and/or its affiliates to communicate with you electronically in connection with this Application and any franchise purchase.
Spouse Personal Information (Use A Separate Application for Partners)
First Name * Last Name * Citizen of: * Permanent Resident of * Date of Birth * Tax ID/National ID/SSN * Optional for additional information purposes but required to begin the process of the purchase and transfer of an existing location. Also note: it will be required prior to the purchase of a new franchise.
Gender * Female Male Are you of legal age? * Yes No Have you ever been associated directly or indirectly with terrorist activities ? * Yes No Has a judgment/lien/bankruptcy been filed against you or have you been involved in any litigation proceeding within the last 5 years? Yes No (If yes, you will need to provide the following for each judgment/lien/bankruptcy proceeding: names of the parties involved, date filed, court where filed and nature of the proceeding.)
What is the highest level of education you have achieved? * College Degree or Higher Highschool Did not complete highschool Did you receive a degree from a college or university? * Yes No Type of degree you recieved? Financial Information (Please List Figures in €)
Income from current occupation (annually) * Income from other sources * Please explain other income Personal Bank(s) Branch Address Individual Liquid Assets (Cash, Stocks, etc.) * Individual Fixed Assets (Home, Car, etc.) * Individual Total Assets * Individual Liabilities (Mortgages, Loans, etc.) * Your Individual Total Net Worth * (Excluding any financing listed below.)
Would this business be your sole income source ? * Yes No Is there other financing not included in (e) above ? * Yes No
Juice Bar Operations
If qualified, when will you invest in a franchise ? * Now Within 6 months 6 months to 1 year Over 1 year How involved will you be in operating the restaurant ? * 0% 50% 100% In what country would you like to open your Beleaf Juice Bar?: * (If different from your country of residence**)
INVESTORS (IMPORTANT NOTE:
In the US and Canada, all investors must be named on any franchise agreement executed in connection with this application, with exception of certain first degree kin. Outside of the US and Canada, we may require that some or all of the investors be named on any franchise agreement executed in connection with this application. All investors to be named on the franchise agreement must fill out a separate application.)
Will you have Investors? * Yes No If not, you may skip this section. Otherwise please complete all relevant sections below.
First Name Last Name % of ownership *Investors are individuals who, in connection with any purchase of a franchise associated with this application, will: 1) contribute money toward the purchase of this franchise; 2) have ownership interest in either the franchise or any entity assigned the right to operate the franchise; or 3) act as co-borrower, co-signer or guarantor of a loan associated with the franchise
I understand that the granting of a franchise is at the sole discretion of the Franchisor (Beleaf Franchise). I understand that I must be a citizen or permanent resident of the European Union to purchase a franchise to be located in the respective country and that I must provide the requisite proof to the Franchisor prior to any franchise sale or transfer. For any franchise to be located outside of the European Union, I understand that I must provide the requisite photo identification to the Franchisor to verify my identity prior to any sale or transfer and upon request during the term of any franchise agreement entered into with the Franchisor.
I understand that any information I receive from the Franchisor or from any employee, agent or franchisee of the Franchisor or its affiliate is highly confidential («Confidential Information»), has been developed with a great deal of effort and expense to the Franchisor, and is being made available to me solely because of this application. I agree that I shall treat and maintain all Confidential Information as confidential, and I shall not, at any time, without the express written consent of the Franchisor, disclose, publish, or divulge any Confidential Information to any person, firm, corporation or other entity, or use any Confidential Information, directly or indirectly, for my own benefit or the benefit of any person, firm, corporation or other entity, other than for the benefit of the Franchisor.
I authorize the Franchisor or its designee to procure an investigative consumer report, a general background search and an investigation in accordance with anti-terrorism legislation. I understand that these Investigations may reveal information about my background, character, general reputation, mode of living, association with other individuals or entities, creditworthiness, litigation history and job performance (collectively referred to as “Investigation Data”). I understand that, upon written request, within a reasonable period of time, I am entitled to additional information concerning the nature and scope of these Investigations. I hereby release any representative of the Franchisor or its affiliate, a credit bureau, security consultant or other investigative service provider selected by the Franchisor, its affiliates, officers, agents, employees, and/or servants (collectively referred to as the “Investigator”) from any liability arising from the preparation of these Investigations.
This authorization for release of information includes but is not limited to matters of opinion relating to Investigation Data. I authorize all persons, schools, companies, corporations, credit bureaus, law enforcement agencies or other investigative service providers to release such information without restriction or qualification to the Investigator. I voluntarily waive all recourse and release them from liability for complying with this authorization. This authorization/release shall apply to this as well as any future request for these Investigations by the above-named individuals or entities. I authorize that a photocopy or facsimile of this release is considered as valid as the original. Everything that I have stated in this application is true and I understand that the information provided by me will be relied upon by the Franchisor. In accordance with anti-terrorist legislation, I understand that I will not be approved to purchase a franchise if I have ever been a suspected terrorist or associated directly or indirectly with terrorist activities. I read, understand, and agree to all of the above. Additionally, I understand that the Franchisor may require me to pass a standardized Math and English exam. I understand that I will be required to provide the Franchisor with copies of my bank statements for the past three (3) months as verification of the liquid assets listed in my financial statement submitted to the Franchisor.
I have read the above disclaimer. *
I consent to receive any documents for franchise disclosure purposes through electronic means (if available in my country). Signatures
Type name to indicate consent. Signature required at time of sale.
Applicant’s Typed Name * Spouse’s Typed Name *