732-333-8035 erin@thinkbrainiac.com

Please Complete The Information Below and Submit The Application

All information is confidential and will not be used for any other purpose, except for obtaining potential franchisee’s personal and financial information. By submitting this Application you are allowing us to do a background check based on the information you provided.

* Required Fields

E-mail Address *
Phone Number *
Address *
City *
State *
Zip Code *
Social Security Number *
Who wil sign the Franchise Agreement *
Will you have a Partner? Name? *
Location Desired For Center *
Highest level of education *
Have you ever been convicted of a crime? *
Do you have the $13,000 or $19,000 Franchise Fee? *
Do you have the required opening capital? *
Month you would like to open *
Have you ever owned your own business? Type? *
Current Checking Account Bal *
Current Savings Account Bal *
Total stocks, bonds & other financial investments *
Bank Name *
Have you ever filed for Bankruptcy *
Last or current employer *
Why do you want to be a Brainiac Franchise Owner *
Internet Signature Required *
Internet Signature Required *
I have read and agree to the Privacy Policy *

Legal Disclaimer

This application form is not intended as an offer to sell or the solicitation of an offer to buy a franchise. We offer franchises solely by means of our Franchise Disclosure Document.