PTI Request For Consideration

Personal Information

First Name:*

Last Name:*

Address:*

City:*

State:*

Zip:*

How long at this address:

Home phone:*

Work phone:

Mobile phone:

Can we call you at work? Yes No

Email:*

Are you a US citizen? Yes No

Marital status:

Spouse's name:

Spouse's occupation:

Spouse's annual salary:

Names and ages of dependents:

Education

Name of school/college:

Degree/year:

Describe any experience in sales, management or the fitness industry. Include fitness &/or nutrition certifications:

Business Experience

From - To (years)	Company/Address	Position	Annual income

Business Goals and Objectives

Will you be an owner-operator or investor? Owner-Operator Investor

Do you plan to have a business partner?* Yes No

Will your partner be active? Yes No

Please list your preferences for locations (City & State):1st 2nd 3rd

What motivated you to pursue this business opportunity?

Why do you feel that you will be successful in owning this franchise?

Financials*

Assets		Liabilities
Cash in checking account	$	Primary residence (1st mortgage)	$
Cash in savings account	$	Primary residence (2nd mortgage)	$
Stocks/Bonds/IRAs/401K	$	Other real estate mortgages	$
Certificates of deposit	$	Credit cards	$
Value of primary residence	$	Automobile loans	$
Value of other real estate (owned)	$	Other installment loans (please list)
Autos (owned)	$		$
Other Assets (please list)			$
	$	Other liabilities (please list)
	$		$
	$		$

Have you ever defaulted on a loan or declared bankruptcy? Yes No

If yes, please explain:

What sources of funds do you plan to use to open this business?

Source	Amount
	$
	$
	$

What level of income do you require to earn from your business? Year 1 $ Year 2 $ Year 3 $

Any other comments you feel we should be made aware of?

It is understood that the purpose of this application is for general information and is in no way binding upon either Personal Training Franchise Ventures, LLC or the applicant. It is understood that the applicant supplies the information contained herein to the best of his or her knowledge and ability and that Personal Training Institute relies on this fact in assessing the desirability and qualification of the applicant. You will be contacted by us after we review the application.

*If you have a business partner, he or she will be required to submit a separate Confidential Request for Consideration.

This is not an offer for a franchise. An offer for a franchise is made only by the means of the franchisor's Franchise Disclosure Document (FDD). This advertisement is not an offering. An offering can only be made by a prospectus filed with the New York State Department of Law. Such filing does not constitute approval by the Department of Law.

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