Franchise Application

Request More Information

Thank you for your interest in Verlo® Mattress Factory Stores. We appreciate you taking the time to fill out this form. After you click "Submit", someone will contact you within 24 hours.

Please note: you will receive one email from us containing an access code. This is not spam, but is information pertinent to your request. Please keep this email for future reference.

Verlo franchises are NOT available outside of the US. If you are interested in an international operation, please visit Island Bedding & Furniture, our international licensing opportunity.

* Indicates a required field.

 Personal Information

* First Name:
 * Last Name:
*Date of Birth:
/ / 		* Social Security Number:
- -
US Citizen Yes No
Marital Status Yes No

Spouse's Name:
Spouse's Date of Birth:
/ / 		Spouse's Social Security Number:
- -
Home Ownership Yes No
* Address 1:
Address 2:
* City:
 * State:
 * Zip:
* Phone:
 * Email Address:
Mobile Phone: FAX
Time Zone:
 Best Time to Call:
*Have you ever been convicted of a felony? Yes No
*Have you ever filed for bankruptcy? Yes No
* Date Filed:
/ / 		* Date Discharged:
/ /
 Assets & Liabilities
Assets:
Liabilities:
* Cash on Hand & in Bank ($)
 * Mortgages ($)
* Marketable Securities ($)
 * Accounts Payable ($)
* Accounts / Notes Receivable ($)
 * Notes Payable ($)
* Retirement Plans ($)
 * Loans on Life Insurance ($)
* Real Estate ($)
 * Credit Cards (Total Balance) ($)
* Personal Property ($)
 * Unpaid Taxes ($)
* Business Holdings ($)
* Life Insurance (CSV) ($)
* Other Assets ($)
 * Other Liabilities ($)
Description
Total Assets
 Total Liabilities
Total Net Worth
 Other Sources of Income
Salary ($)
 Investment Income ($)
Real Estate Income ($)
 Other Income ($)
Total
* Amount of cash available for investment:
* Have you been approved for financing? Yes No
* Would this business be your sole income source? Yes No
 Business Experience
* Upload resume here:
* Have you previously owned a business? Yes No
What Type?
* Was it a franchise? Yes No
How long did you own it?
Where was it located?
 Ideal Market Information
* Do you plan to devote full time to your business? Yes No
* Do you plan to have partner(s)? Yes No
* Name
 * Email
* Name
 * Email
Pending a favorable evaluation, how quickly do you intend to pursue franchise ownership?
Are you interested in opening a single unit or multiple units?
What is your preferred market area?
* (First Choice)
 (Second Choice)
* How did you hear about Verlo® Mattress Factory Stores?
Questions or comments? Please type any immediate questions you may have in this box, to be discussed with your recruiter.

In submitting this Franchise Application, I understand a background check may be made whereby
information is obtained regarding my character, employment history, education, licenses, credentials,
credit history, driving record and criminal history. I agree to indemnify and hold harmless
Verlo® Mattress Factory Stores, LLC (hereafter VMFS, LLC), and its affiliates from all liability
and damages whatsoever in obtaining, furnishing or using said information. In the event of VMFS, LLC,
awarding a franchise, I understand that false or misleading information given in this application, on
my resume, in interview(s) or on related company documents may result in immediate cancellation of
my application. If awarded a franchise, I also understand that I am required to abide by all franchise
rules, regulations and policies of VMFS, LLC.


I understand receipt of this application by VMFS, LLC, does not imply that a franchise has been awarded
and that this application is not a contract to award a franchise. All information contained herein will
remain personal and confidential, and will only be used for franchise qualification with VMFS, LLC,
or its affiliates.