Skin & Skinny Affiliate Application Form

Photo Biotech Laser Aesthetic Clinic

Consult with our Business Development Specialists

Skin & Skinny Affiliate Application Form

Affiliate/ FRANCHISE APPLICATION FORM Any information detailed on this form will be treated in a strictly confidential manner. We utilize the information provided on this form for the sole purpose of evaluating prospective affiliates/ franchisees, and will not sell or provide this information to any other party without the written consent of the applicant. If the applicant is not successful in purchasing a med spa or day spa immediately, the Application form will be kept on file for other opportunities, up to a maximum period of one year from the date shown below. If you do not wish this application to be kept on file, please advise us when this form is submitted. Please note that although every possible precaution is taken to protect the confidentiality of this application form, Photo Biotech. and subsidiary companies cannot be held responsible in the event that the information contained is obtained by a third party by any unforeseen situations.

    Date

    Business Experience

    Have you ever owned a business before?

    Present Occupation:

    Company 1

    Previous Experience:

    Company 2

    Company 3

    Education Circle last year of school completed:

    High School

    DETAILED SUMMARY LISTING OF ASSETS

    INDIVIDUAL ASSET INFORMATION AMOUNT
    Accounts Receivable:
    Annuity:
    Boats:
    Bonds
    Business Property and Real Estate:
    Certificate of Deposit:
    Home Value
    2nd Home value:
    Household Furnishings:
    Jewelry:
    Life Insurance:
    Mutual Funds:
    Notes Receivable:
    Other Assets:
    Other Real Estate:
    Personal Residence Real Estate:
    Recreational Equipment:
    Retirement Plans:
    Savings Accounts:
    Checking Account
    Stocks:
    Trusts:
    Vehicles
    INDIVIDUAL TOTAL ASSET VALUE: $0.00

    DETAILED SUMMARY LISTING OF LIABILITIES

    INDIVIDUAL LIABILITY INFORMATION AMOUNT
    Mortgage or Rent:
    Home Equity Loan:
    Other Mortgage:
    Vehicle Loans:
    Credit Cards:
    Student Loans:
    Other Liabilities:
    INDIVIDUAL TOTAL ASSET VALUE: $0.00

    DETAILED SUMMARY LIST OF MONTHLY INCOME ASSET

    INDIVIDUAL MONTHLY INCOME MONTHLY AMOUNT
    Monthly Salary or Wages:
    Investment Accounts:
    Alimony:
    Child Support:
    Trusts:
    Other Income Sources:
    INDIVIDUAL TOTAL MONTHLY INCOME ASSET: $0.00

    DETAILED SUMMARY LIST OF MONTHLY EXPENSE LIABILITY

    INDIVIDUAL MONTHLY EXPENSES MONTHLY AMOUNT
    Paid Alimony:
    Paid Child Care:
    Paid Child Support:
    Groceries:
    Healthcare or Medications:
    Housing or Rent:
    Other Mortgage Loans:
    Auto Loans:
    Auto Insurance:
    Health or Dental Insurance:
    Life Insurance:
    Other Insurance:
    Credit Cards:
    Student Loans:
    Other Expenses:
    INDIVIDUAL TOTAL MONTHLY EXPENSE LIABILITY: $0.00

    NET WORTH SUMMARY

    TOTAL ASSETS: $0.00
    TOTAL LIABILITIES: $0.00
    TOTAL NET WORTH: $0.00

    I, , hereby certify and warrant, to the best of my knowledge, that the above mentioned information contained within this Personal Financial Statement is true, accurate and complete.

    Personal Financial continued

    Which specific assets do you intend to use to meet the cash requirement?

    a)
    b)
    c)
    d)

    References Business (to be contacted after interview)

    Business 1

    Business 2

    Personal (not relatives)

    Personal 1

    Personal 2

    Bank and Credit

    Bank and Credit 1

    Bank and Credit 2

    Bank and Credit 3

    If additional space is required, please do not hesitate to attach extra sheets of paper. The undersigned hereby certify that the information given in the foregoing statement is true and that no unfavourable information known to me (us) or called for herein has been omitted. Photo Biotech and associates. are hereby authorized to obtain such information as it may require concerning said statement which at all times shall remain property of Photo Biotech and associates. For the purpose of determining my eligibility for a affiliate franchise, you are authorized to procure consumer reports from credit reporting agencies and obtain personal and credit information from persons or consumer reporting agencies. It is understood that all information provided in this application and obtained pertaining to same will be treated confidentially by Photo biotech and associates.

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