Franchise Application

Find out more about how you can enter this growing and rewarding industry by owning your own Miracle Leaf Franchise.

For more information simply fill out the required fields below:

Name*
First Last
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Registered Business Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Office Tel
Mobile Tel*
Email*
In which geographical areas do you currently operate your business in?
In which geographical areas would you like to operate Miracle Leaf Clinics?
EDUCATION
Higher Education and Qualifications: (Education since leaving school including professional qualifications)
Course Description
Qualifications
Year
Name and Address of Institution
REFERENCES
Please provide details of two business references. (No contact will be made until we have a mutual agreement to your entering our franchising program.)
Reference 1
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference 2
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
CAREER AND BUSINESS HISTORY
***Please add at least 2 Experiences/Companies
Employer's Or Business Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date Started
MM slash DD slash YYYY
Date Ended
MM slash DD slash YYYY
Type of Business
Position Held
Duties and Responsibilities
Reason for Leaving
FINANCIAL STATEMENT
Personal Financial Statement – for the last full financial year
Salary/Draw
Bonus/Commission
Dividends/Interest
Income from property
Profit of your Business
Other Income (Please Specify)
Spouse Income
Total
Do you have an other business interests? Please specify
ASSETS & LIABILITIES
Cash
Shares
Properties and Market Value
Current Assets
Inventory
Net Business Value
Total Assets
Liabilities
Loans
Mortgages
Current Liabilities
Other Liabilities/ Invoices Due
Any Other Debts
Total Liabilities
Other Financial Information
What is your average monthly cash on hand?
How much capital do you have available to invest in this business? (minimum $100k of liquid assets)
Have you, your current or previous company or your spouse ever been declared or filed for bankruptcy? Please provide details
Have you or your business ever been prosecuted, or been involved in a dispute? (i.e., county court judgement etc)
Have you ever been involved in a business failure? Please provide details
Have you ever been convicted of a criminal offense? Please provide details
Describe why you believe that you can be a successful Miracle Leaf Franchisee:
Additional Information
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This website and the information contained herein does not constitute the offer or sale of a franchise. There are certain states that require the registration of a FDD before the franchisor can advertise or offer the franchise in that state. This franchise may not be registered in all registration states and may not offer franchises to residents of those states or to persons wishing to locate a franchise in those states until compliance guidelines are met. The offer and sale of a franchise can only be made through the deliveryand receipt of a Franchise Disclosure Document (FDD).

Find out more about how you can enter this growing and rewarding industry by owning your own Miracle Leaf Franchise.

EDUCATION

REFERENCES

CAREER AND BUSINESS HISTORY

FINANCIAL STATEMENT

ASSETS & LIABILITIES

Other Financial Information