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Online Application Form

Confidential Franchise Questionnaire

Name*
Address*
City*
State*
Zip Code*
Home Phone*
Office Phone*
Email Address*
Length of time at above address
Previous Address
Age
Date of Birth  (MM/DD/YY)
Social Security No
Marital Status* Single Married
Previous work experience, starting with the most recent
Company Address Position No of Years
Education
Last year of school completed
College Degree Yes No
Health
Health Status
Illness/Disability
Attorney
Attorney’s Name
Telephone No
Business Options
Gateway Store Location(s) of Interest
When are you available to open business
Will you work in the business Full-Time   Part-Time
Will you have a partner Yes No
If so, will your partner be active Yes No
Background Check
Have you ever been convicted
of a Felony or misdemeanor (Other than a traffic
violation) or are you currently involved in
a criminal proceeding:		 Yes No
If yes, please state details
Have you ever taken bankruptcy Yes No
If yes, state place and date
Reason for Bankruptcy
Income Status
What is your current annual income (Including sources other than your salary)
References (To be contacted after interview)
Name Position Address Telephone No
Financial Information
As of   (MM/DD/YY)
  Assets   Liabilities
Cash on Hand Notes Payable
Securities To Banks
Cash Value of Insurance Due Others
Other Investments Mortgages
Personal Items Home
Autos Real Estate
Home Other
Other Real Estate Installments/Loans
Value of other Business Other Obligations
Other Assets    
       
Total Assets Total Liabilities
Net Worth    
Bank & Credit References
Name Address Telephone No
Credit Cards Held VISA MasterCard American Express
Please note the items that you would convert to cash, if necessary, to meet the initial requirements of Gateway Newstands
Financing
Capital Available   $50,000.00   $75,000.00  $100,000.00 or more
Will you require assistance to obtain financing Yes No
Business Contribution
What do you feel will be your most important contribution to your business
I, hereby declare that all the information provided herein is to the best of my knowledge true, complete and correct and I understand that it may be used to determine my credit worthiness. In order to assess my ability to meet my financial obligations, I authorize Gateway Newstands and its agents or assigns by submitting this on-line application: i) to request and obtain personal information about me on an ongoing basis from credit bureaus from information they previously collected about me in order to assess my credit history; ii) to exchange my personal information on an ongoing basis with credit bureaus in order to protect me, ensure the completeness of the information and maintain the integrity of the credit granting system; iii) to co-operate with local, provincial and national authorities in the investigation of unlawful or improper activities in order to protect me and you from fraudulent transactions; and iv) disclose your personal information where necessary to protect my interests, and yours.