FRANCHISE APPLICATION

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Marital Status Marital Status Single Married Other

Homeownership Homeownership I rent I own my home

How did you hear about us? How did you hear about us?Through a friendSocial mediaAdvertisingOur websiteOther

Have you ever owned, or do you currently own, a business in the United States? Have you ever owned, or do you currently own, a business in the United States? Yes No

Would you like to open a business in the United States? Would you like to open a business in the United States? Yes No

Are you already familiar with the BE MED PT Franchise business offer? Are you already familiar with the BE MED PT Franchise business offer? Yes No

Do you have experience with franchise business models? Do you have experience with franchise business models? Yes No

Would you like to acquire a BE MED PT franchise in Florida? Would you like to acquire a BE MED PT franchise in Florida? Yes No

When? When? Within a month Within the next quarter Within the next six months N/A

Are you considering other franchise opportunities? Are you considering other franchise opportunities? Yes No

How does your spouse or family feel about you owning your own business? How does your spouse or family feel about you owning your own business? They support me They have doubts They do not support me

How will you finance your franchise investment? How will you finance your franchise investment? Personal funds Third-party financing

Will you have one or more partners? Will you have one or more partners? Yes No

Have you ever signed a contract or non-compete agreement that could limit or disqualify you from owning or operating a franchise? Have you ever signed a contract or non-compete agreement that could limit or disqualify you from owning or operating a franchise? Yes No

Who will be responsible for the day-to-day operation of your business? Who will be responsible for the day-to-day operation of your business? A family member A friend An experienced manager

Have you ever been convicted of a felony? Have you ever been convicted of a felony? Yes No

If you answered yes, please explain

Are you now, or have you ever been, involved in any litigation, either as a defendant or plaintiff? Are you now, or have you ever been, involved in any litigation, either as a defendant or plaintiff? Yes No

If you answered yes, please explain

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