I hereby certify that the above information contained in this Franchise Application is true and correct. I understand that the above information will be utilized by The Lice Place in its evaluation of my expression of interest in acquiring The Lice Place franchise. I understand that in submitting this application I am not agreeing to be obligated to acquire The Lice Place franchise and that acceptance of my application is not an agreement to grant me a franchise opportunity, which will only occur upon execution of a Franchise Agreement. I further understand that if The Lice Place decides to proceed with my application, I will be provided, prior to execution of any binding agreement, with a Franchise Disclosure Document.
In accordance with the Privacy Act (5 U.S.C. 552 a), Freedom of Information Act, and the Fair Credit Reporting Act, I expressly authorize any past or present employer, any law enforcement agency (federal, state, or local), or any person who has personal knowledge of my character, work experience, or criminal records to release information to The Lice Place. I understand and acknowledge that as a condition of being considered for The Lice Place franchise, I agree to a credit history check and a criminal background check to be performed by a reputable agency at the choice of The Lice Place. I understand that the credit and criminal reporting agencies will make their results known to The Lice Place, and The Lice Place may use those results, in whole or in part, in determining whether I will be granted the right to enter into a Franchise Agreement with The Lice Place. If requested by The Lice Place, I agree to supply statements from my professional advisors (banker, broker, accountant, or attorney) verifying the assets stated on the application, and I also agree, if requested, to furnish copies of Federal Income Tax Returns (along with any supporting Schedules) as filed for the last three years. I understand that The Lice Place is relying upon all of the information contained in this application as a material factor in considering my application to become a franchisee, and I therefore agree to promptly notify The Lice Place of any material change in any of this information or any subsequent information provided to The Lice Place. In addition, I release from liability and hold harmless all persons releasing personal, professional, or financial information on me or any company to which I am a partner or shareholder listed on this application.
I further agree to provide a detailed resume and a current personal financial statement upon the request of The Lice Place.