PTI Request For Consideration

We welcome your interest in Personal Training Institute (PTI) franchise opportunities. To determine if you qualify for a PTI franchise, please fill out the following form. The completion of this form does not obligate you, nor does it constitute an offer of a franchise by PTI. * (Astericked fields are required)
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:	Married Single Separated Divorced Domestic Partner Widowed Other
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
Last Job
From - To (years)
Company/Address
Position
Annual income
Prior Job
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 1:	Yes   No
Will your partner be active:	Yes   No
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
Cash in checking account:	$
Cash in savings account:	$
Stocks/Bonds/IRAs/401K:	$
Certificates of deposit:	$
Value of primary residence:	$
Value of other real estate (owned):	$
Autos (owned):	$
Other Assets (please list):
:	$
:	$
:	$
Liabilities
Primary residence (1st mortgage):	$
Primary residence (2nd mortgage):	$
Other real estate mortgages:	$
Credit cards:	$
Automobile loans:	$
Other installment loans (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.
1 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. ©2011 Personal Training Franchise Ventures, LLC. All Rights Reserved.