Potential Franchisee Questionnaire

Please complete and submit the form below. Take your time and verify the information that you are putting into this form. You may be requested to provide confirmation of any assets listed. You may also visit www.zillow.com to research current real estate value(s). If you have any questions on this form, please contact Cathy at 651.438.5055 or email opportunities@anytimefitness.com.

Note: Do not use commas (,) when entering numerical values.

Personal Information

First Name*
Last Name*
Date*
Address 1*
Address 2
City*
State/Province*
Zip Code/Postal Code*
Phone Number
Contact at Work* Yes No
Email*
Marital Status*
Spouse First Name
Spouse Last Name

Partner Information

If you are considering a partnership for this franchise, please complete the following information about your prospective partner.

First Name
Last Name
Address 1
Address 2
City
State/Province
Zip Code/Postal Code
Phone Number
Contact at Work Yes No
Email
Marital Status
Spouse First Name
Spouse Last Name

Current Employment

Company Name*
Title*
Start Date*
Company Address 1*
Company Address 2
Company City*
State/Province*
Zip Code/Postal Code*

Fitness Experience

If applicable, please describe any previous fitness industry experience:

Priorities - As you consider franchising opportunities with Anytime Fitness, please rank what's most important to you, with 1 being your highest priority.

Income opportunity*
Ability to work for myself*
Balanced lifestyle (time with family, time for hobbies, etc.)*
Passion for fitness*
Passion for turning my community & the world into a healthier place.*
Challenge of opening & running a new business*
Working with partners (spouse, friend, etc.)*
Other

Concerns - Please also rank your level of concern in the categories below, with 1 being your biggest concern.

Industry growth & future*
Capital requirements to get started*
Anxiety over being self-employed*
Competition from other fitness centers*
Risk of failure*
Lack of fitness industry experience*

Club Operations

Do you plan on working full time at your Anytime Fitness club* Yes No
Does at least one of your partners plan on working full time at the club?* Yes No

Location/Demographics

Proposed City 1*
Proposed State/Province 1*
Population 1*
Nearby Cities 1*
Proposed City 2*
Proposed State/Province 2*
Population 2*
Nearby Cities 2*

Assets

Cash on Hand (checking/savings)*
401K/IRA/Profit Sharing Plan*
Notes/Accounts Receivable (Schd. 5)*
Marketable Securities (Schd. 2)*
Life Insurance (Cash value only - Schd. 4)*
Homestead Owned (Schd. 1)*
Other Real Estate (Schd. 1)*
Automobile(s)*
Equity Value in Existing Business (Schd. 3)*
Other Personal Property*
Other Assets (specify separately)*
Total Assets*

Liabilities

Mortgage on Homestead (Schd. 1)*
Home Equity or Line of Credit*
Auto Loans*
Credit Cards (balance of all)*
Other Loans (property/personal)*
Accounts Payable (Schd. 6)*
All Other Liabilities*
Alimony/Child Support (balance)*
Taxes Owed*
Total Liabilities*
Net Worth (assets minus liabilities)*
Total Liabilities & Net Worth*

Income

Salary/Wages *
Commission/Bonuses*
Rental Income*
Investment Income*
Business Income*
Other Income*
Total Income*
Co-Applicant Salary & Wages*
Co-Applicant Commission/Bonuses*
Co-Applicant Rental Income*
Co-Applicant Investment Income*
Co-Applicant Business Income*
Co-Applicant Other Income*
Co-Applicant Total Income*

Monthly Liabilities

Mortgage or Rent (Homestead)*
Mortgage or Rent (Other Real Estate)*
Insurance/Property Taxes*
Auto Loan/Lease Payment*
Credit Card Payments*
Alimony/Child Support Payment*
Liens/Judgements*
Other Debt*
Total Liabilities*
Co-Applicant Mortgage or Rent (Homestead)
Co-Applicant Mortgage or Rent (Other Real Estate)
Co-Applicant Insurance/Property Taxes
Co-Applicant Auto Loan/Lease Payment
Co-Applicant Credit Card Payments
Co-Applicant Alimony/Child Support Payment
Co-Applicant Liens/Judgements
Co-Applicant Other Debt
Co-Applicant Total Liabilities

Real Estate Owned

Type of Property 1
Address of Property 1
Purchase Date 1
Original Cost 1
Current Market Value 1
Mortgage Balance 1
Monthly Payment 1
Type of Property 2
Address of Property 2
Purchase Date 2
Original Cost 2
Current Market Value 2
Mortgage Balance 2
Monthly Payment 2
Type of Property 3
Address of Property 3
Purchase Date 3
Original Cost 3
Current Market Value 3
Mortgage Balance 3
Monthly Payment 3

Marketable Securities

Name of Security
Number of Shares
Purchase Cost
Date Purchased
Current Market Value
Name of Security
Number of Shares
Purchase Cost
Date Purchased
Current Market Value

Equity in Existing Businesses

Name of Business 1
Ownership % 1
Date Ownership Acquired 1
Equity Value of Ownership 1
Name of Business 2
Ownership % 2
Date Ownership Acquired 2
Equity Value of Ownership 2
Name of Business 3
Ownership % 3
Date Ownership Acquired 3
Equity Value of Ownership 3

Life Insurance

Insurance Company 1
Face Value 1
Cash Surrender Value 1
Beneficiary 1
Insurance Company 2
Face Value 2
Cash Surrender Value 2
Beneficiary 2
Insurance Company 3
Face Value 3
Cash Surrender Value 3
Beneficiary 3

Notes/Accounts Receivable

Debtor 1
Description of Receivables 1
Repayment Terms 1
Per
Balance Due 1
Debtor 2
Description of Receivables 2
Repayment Terms 2
Per
Balance Due 2
Debtor 3
Description of Receivables 3
Repayment Terms 3
Per
Balance Due 3

Notes/Accounts Payable

Payee 1
Description of Liability 1
Repayment Terms 1
Per
Unpaid Balance 1
Payee 2
Description of Liability 2
Repayment Terms 2
Per
Unpaid Balance 2
Payee 3
Description of Liability 3
Repayment Terms 3
Per
Unpaid Balance 3

Other Information

Have you ever filed for bankruptcy?* Yes No
Please Explain
Are you currently or have you been the defendant in any suits or legal actions?* Yes No
Please Explain
Has a tax lien ever been filed against you, your personal property, a business in which you have held ownership, or any business property in which you have held ownership?* Yes No
Please Explain

I authorize Anytime Fitness, LLC. and its Assigns to make inquiries as necessary to verify the accuracy of the statements made and to determine my creditworthiness. I certify the above and the statements contained in the attachments are true and accurate as of the stated dates. These statements are made for the purpose of either obtaining commercial credit or guaranteeing commercial credit. I understand FALSE statements may result in forfeiture of benefits and possible prosecution by the U.S. Attorney General (Reference 18 U.S.C. 1001). Anytime Fitness, LLC may share your personal financial statement with its affiliates, if necessary.