DISCLOSURE AND CONSENT CONCERNING CONSUMER, CREDIT AND CRIMINAL REPORTS FOR FRANCHISE APPLICANTS.
You should read this carefully. This consent and release has been provided to you in order for us to request character, background, motor vehicle record, financial and credit, and criminal reports in connection with your application as a franchisee. By signing below, you acknowledge that we
may now or in the future verify information relating to your character, experience and activities (including by way of example and work experience), or financial or credit history, criminal and other background. The verifications and/or checks may include but are not limited to: driving record, credit bureau files, employment references, personal references, any educational and licensing institution and to receive any criminal record information in the files of any Federal, State, or Local criminal justice agency in the United States. A photocopy, telephonic facsimile (Fax) or e-mailed consent of this Consent and Release shall be valid as the original. The results of this verification process will be used in assessing your candidacy by Emerging Franchises as a franchisee on behalf of their clients to allow you access to training programs and confidential materials, and to enter into an agreement with you. All results will be kept confidential. The information obtained will not be provided to any parties other than to designate Company Personnel. According to the Fair Credit Reporting Act, if any adverse decision is made with regard to your application based
entirely or in part on the information contained in a consumer, credit or criminal report prepared by a consumer reporting agency, you are entitled to receive a copy of this report upon written request, and a disclosure of the nature and scope of the investigative report. Your signature below indicates that you have carefully read and understand that consumer; credit and criminal reports may be requested and reviewed for franchising purposes. Additionally, your
signature below reflects your understanding that such consent will remain in effect indefinitely until you revoke it in writing.
YOU’RE CONSENT STATEMENT:
I expressly authorize any past or present employer, any law enforcement agency, and any person who has knowledge of my character, experience and activities (including by way of example, education or work experience), or financial or credit history to release this information to Emerging Franchises about me, then to the extent that person is or would be liable to me in any way as a result of furnishing such information, I release such person from such liability. In addition, I authorize the procurement of an investigative background search in accordance with anti-terrorism legislation, such as the USA Patriot Act and Section 1 of U.S. Executive Order 13224, issued September 23, 2001. I also certify that neither I nor any of my funding sources is or has ever been a terrorist or suspected terrorist, or a person or entity described in the aforementioned legislation. I understand that my application will not be approved if I have ever been a suspected terrorist or associated in any way with terrorist activities. I have carefully read and understand this disclosure and consent form and by my signature consent to the release of character, background, motor vehicle record, financial and credit, and criminal reports in conjunction with my application to develop or purchase a Franchise (clients of Emerging Franchises only) further understand that any and all information contained in my application, or otherwise disclosed to you by me, may be utilized for the purpose of obtaining the consumer, credit, and other civil and criminal investigative reports as they consider necessary to evaluate this Application, and I understand that these reports may contain information about my background, mode of living, character and personal reputation. This authorization is valid for any current and future reports and updates that may be requested and you agree to execute all additional documents, waivers or releases that might be necessary for Emerging Franchises or its agents and designees to obtain such information or reports. I further authorize Emerging Franchises and its agents and designees to contact individuals or entities identified in this Application, or whose names arise in connection with the civil and criminal investigative reports described above for purposes of obtaining character references and verifying the information contained in this Application. I authorize all financial institutions holding funds or other property on my behalf or on behalf of any business entity in which I hold a beneficial interest, whether or not identified in this Application, to release all records including signature cards, statements and all documentation reflecting the source of deposited funds, whether the funds were received were received in the form of cash, credit, electronic fund transfer or wire transfer. I authorize Emerging Franchises and any of its Agents/designated Company Personnel, to disclose orally and in writing the results of these reports to their authorized representatives. I understand that Emerging Franchises will be requesting information from various companies, financial and other institutions, universities, credit reporting agencies, professional and academic certification law enforcement agencies, former employers, and/or the military, and I hereby authorize such entities to release any information that they may have about me to Emerging Franchises and its agents and designees. I do hereby authorize any individual, and I release them Emerging Franchises or their associates to the full extent permitted by law from any claims, damages, losses, liabilities, costs and expenses, or any other charge or complaint arising from the release, retrieving and reporting of such information. I, the undersigned applicant, do hereby certify that the information provided by me for the purpose of being considered as a Emerging Franchise (clients) franchisee or licensee is true and complete as of
the date below to the best of my knowledge. If there is any material change in the information submitted here or later submitted by me during the Franchise Application process with Emerging Franchises I will promptly notify in writing of the change or formally withdraw my application so that Emerging Franchises does not rely on information that to my knowledge has become incorrect or incomplete in any way. I understand and acknowledge that my franchise (if awarded) may be terminated without notice if I knowingly either inaccurately report or fail to report any
information as part of my application or qualification as a franchisee. The completion of this report places no continuing obligation on Emerging Franchises or its agents or the prospective.