Medico Franchise Application Form

Medico Franchise Application Form

At Medico, we hold the conviction that our franchise associates should be deeply committed to respect and the spirit of entrepreneurship. Having experience in multi-unit testing operations is an advantage, but not a prerequisite. Medico is not a part-time job or a side hustle. We demand a full-time commitment, seven days a week. We maintain late working hours to cater to our customers who require on-call services. If a seven-day work week and extended hours don't align with your lifestyle, Medico may not be the best fit for you. Here are the qualities we seek in our potential Medico franchise associates:• Exceptional Customer Service Skills• Excellent Communicators• Confident Individuals• Organized Professionals• Driven and Motivated• Positive and Optimistic People• Community Oriented• Receptive to Coaching• Team Oriented Individuals.
Become a Franchise owner today!
Name*

First NameLast Name
DATE OF BIRTH*
Personal Phone Number*

Area CodePhone Number
Business Phone Number*

Area CodePhone Number
Personal Email Address*
Business Email Address*
Address*

Street Address

CityState / Province

Postal / Zip Code
Do you have startup money today?*

YESNO
Available Capital for Investment*
Credit Score*
How soon are you looking to get started?*

RIGHT NOW3 MONTHSUNSURE
HOW MANY PARTNERS WILL BE JOINING?*
Why do you want to own your own Medico Diagnostics Center?*
Do you already have a location?*

YesNo
How many employees will you have?*
What state will you be operating in?*
Have you worked in health care before?*

yesno
Have you worked in a medical laboratory before?*

yesno
Are you willing to do what it takes to make your business successful?*

yesno
EMPLOYMENT HISTORY
POSITION
COMPANY
DATE OF EMPLOYMENT

MonthDayYear
Date
RESON FOR LEAVING
POSITION
COMPANY
BUSINESS OWNERSHIP EXPERIENCE (if applicable)
TRADING NAME
NATURE OF BUSINESS
YEARS OF TRADE
IS THE BUSINESS STILL OPERATING?

YESNO
TRADING NAME
NATURE OF BUSINESS
YEARS OF TRADE
IS THE BUSINESS STILL OPERATING?

YESNO
REFERENCES
COMPANY NAME *
CONTACT NAME*
Phone Number*

Area CodePhone Number
COMPANY NAME *
CONTACT NAME*
Phone Number*

Area CodePhone Number
OTHER BACKGROUND INFORMATION

Have you or any applicable partners, officers, directors, or shareholders with your business affiliations ever:
Had any administrative, criminal or civil action alleging a violation of any franchise law, fraud, embezzlement, fraudulent conversation, restraint of trade, unfair or deceptive practices, and misappropriation of property or comparable allegations? Please note that FISHWAVE reserves the right to request a copy of your criminal record from the relevant State Police Authority.*

YESNO
Been convicted of a felony or pleaded “no contest” to a felony charge or been held liable in a civil action by a final judgement or been the subject of a material complaint or other legal proceeding such as a felony, civil action complaint, misappropriation of property or comparable allegations?*

YESNO
Been adjudged bankrupt or reorganized due to insolvency?*

YESNO
If you answered “Yes” to any of the questions above, please explain: If not N/A*
GENERAL INQUIRY
ARE YOU PREPARED TO COMPLY WITH THE PROCEDURES AND CONTROLS SET BY MEDICO?*

YESNO
Why do you think you will be successful?*
Are your intentions to work full time in the business?*

YESNO
Are you aware certain information provided and/or advised to you is confidential and shall not be divulged to any third person unless the company gives approval?*

YESNO

FINANCE INFORMATION(MONTHLY)*

Rows	INCOME
SALARY 1
SAKARY 2
SHARES
INVESTMENT
OTHERS
TOTAL

FINANCE INFORMATION(MONTHLY)*

Rows	EXPENCES
MORTAGE 1
MORTAG 2
CAR LOAN 1
CAR LOAN 2
CREDIT CARD 1
CREDIT CARD 2
GENERAL LIVING EXPENCES
OTHERS
TOTAL

HOW ARE YOU FUNDING THIS OPPORTUNITY?*

Rows	MONTHLY REPAYMENT
CASH
HOME EQUITY
BUSINESS LOAN
OTHER
TOTAL

FRONT OF DRIVER LICENSE?*

Cancelof
BACK OF DRIVER LICENSE?*

Cancelof