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THE FOLLOWING INFORMATION IS THE BASIS FOR REVIEW BY GOLF ETC. OF AMERICA INC. THE COMPLETION OF THIS DATA DOES NOT OBLIGATE GOLF ETC. OF AMERICA INC. OR ANY OF ITS OFFICERS, DIRECTORS, EMPLOYEES OR AGENTS IN ANY WAY TO ACCEPT YOUR APPLICATION FOR A GOLF ETC FRANCHISE. NO INFORMATION GIVEN HEREIN WILL BE DISCLOSED TO THIRD PARTIES EXCEPT AS REQUIRED BY APPLICABLE LAW, IF ANY.

ALL FIELDS WITH * ARE REQUIRED



RETAILER DATA SHEET APPLICATION
First Name (*)
Please Input Name
Last Name (*)
Please Input Name
Address (*)
Please Input Address
Address 2
Invalid Input
Email (*)
Invalid Input
City (*)
Please Input City
State (*)
Please Input State/Province
ZIP/Postal Code (*)
Please Input ZIP/Postal Code
Country (*)
Please Input Country
Home Phone (*)
Please Input Home Phone
Business Phone (*)
Please Input Business Phone
Cell Phone (*)
Please Input Cell Phone
Age (*)
Please Input Age
Marital Status (*)
Invalid Input
Number of Dependants (*)
Please Input Number of Dependants
Are You A US Citizen (*)
Please Input Are You A US Citizen
Have you ever been convictied of a felony? (*)
Please Input Have you ever been convictied of a felony?
Have you ever filed bankruptcy? (*)
Please Input have you ever filed bankruptcy?
Desired Store Location (*)
Please Input Desired Store Location
Present Employer (*)
Please Input Present Employer
In business for self? (*)
Please Input In business for self?
Positions held during the past five years (*)
Please Input Positions held during the past five years:
U.S. Military or Naval Service (*)
Please Input U.S. Military or Naval Service
Rank
How Long at Present Address (*)
Please Input How Long at Present Address
Area (*)
Please Input Area
Own Home (*)
Please Input Own Home
Plans to Relocate? (*)
Please Input Plans to Relocate?
Mortgage Payments (*)
Please Input Mortgage Payments
Name of Bank where Accounts Presently Held (*)
Please Input Name of Bank where Accounts Presently Held
(*)
Please select all that apply
Approximate Financial Net Worth: $ (*)
Please Input Approximate Financial Net Worth: $
Cash Available to Purchase Franchise (*)
Please Input Cash Available to Purchase Franchise
Amount to be Borrowed (*)
Please Input Amount to be Borrowed
Available When: (*)
Invalid Input
THE ABOVE INFORMATION IS CORRECT AND ACCURATE.

APPLICANTS SIGNATURE (*)
Your Signature is needed
(by checking this box you agree that it will be as if you were to sign the actual document)