NUCO USA Business Member Application

- Nutrition Connection, Inc. - U.S. Government Fitness Center Services

NUCO USA - Business Member Application

Welcome to the NUCO USA New Business Member Application Form! This information will be kept completely confidential at all times.

NOTE: After you have completed the form, you will be taken to the next page which will verify your application submission by requiring you to fill in your email address and clicking on the submit button provided.

NOTE: This form is a FREE service provided by NUCO for individuals who wish to become a NUCO Business Member. You are not obligated by any means to pursue this venture any further if you desire to do so after you submit this form.

All applications are reviewed by NUCO representatives. A representative will contact you within 24 hours of your form submission.

Step 1 of 3

PERSONAL INFORMATION

First Name: *
Last Name: *
Email: *
Mailing Address 1: *
Mailing Address 2:
City: *
State/Province: *	Zip/Postal: *
Country: *
Phone: *
Alternate Phone:
Fax:
Best time to call:
Date of Birth: *
Education:	HS AS BS MS PHD
Marital Status:	Single Married
Spouse's Name:

* Required Fields

BUSINESS EXPERIENCE/SKILLS

Employment History (please list your last three positions)
	Date	Company	Position	Annual Income
1.
2.
3.

Please rate your skills in the following areas:

Skill	Above Average	Average	Below Average
Leadership
Computers/Technology
Creativity
Customer Service
Decision Making
Financial
Sales
Management
Marketing
Networking with People
Organization
Time Management
Training Employees

Step 2 of 3
FUTURE BUSINESS PLANS
	How long have you been seriously looking for a business? 0-3 months 3-6 months Longer than 6 months What other businesses are you exploring? Are you looking to relocate? Yes No If Yes, where? Would you be involved in the business.. Part-Time Full-Time Are you interested in multiple franchise units? Yes No Would friends/family/partners be involved in the business? Yes No When do you want to start your new business? Within 3 months Within 6 months Within a year One year or longer What aspects of business ownership do you find attractive? What skills/experience will make you excel as a business owner? Please add any additional comments regarding your business experience or personal skills you'd like us to know about.

Step 2 of 3

FUTURE BUSINESS PLANS

How long have you been seriously looking for a business?
0-3 months 3-6 months Longer than 6 months

What other businesses are you exploring?

Are you looking to relocate? Yes No
If Yes, where?

Would you be involved in the business.. Part-Time Full-Time

Are you interested in multiple franchise units? Yes No

Would friends/family/partners be involved in the business? Yes No

When do you want to start your new business?
Within 3 months Within 6 months Within a year One year or longer

What aspects of business ownership do you find attractive?

What skills/experience will make you excel as a business owner?

Please add any additional comments regarding your business experience or personal skills you'd like us to know about.

Step 3 of 3

FINANCIAL INFORMATION

Liquid Capital Available for Investment
Net Worth

PERSONAL/BUSINESS REFERENCES

Please list two Personal references and two business references that we may contact:
	Name	Phone	Relationship
1.
2.
3.
4.

LEGAL INFORMATION

Have you or your spouse ever been involved in a personal/business bankruptcy?	No Yes
Have you or your spouse ever been convicted of a crime?	No Yes
Are you or your spouse currently under any type of criminal investigation?	No Yes
Are you or your spouse currently involved in any pending civil lawsuits?	No Yes
Are you or your spouse subject to any civil judgements?	No Yes

If you answered yes to any of the previous five questions, please explain:

How did you hear about NUCO / Nutrition Connection ? *

Everything that you have stated in this confidential questionnaire is true to the best of your knowledge. I further understand that this Application Form is for the purpose of information only. It is not an offer to sell a franchise or business opportunity. Do you agree and understand this statement? Yes No

Name:* Today's Date:*