PART I:
Fill in the form below providing us with a brief profile of yourself: (if you are considering a franchise with a partner(s), each participant should complete a form)

Date:
Name:
Permanent Address:
City:
State:
Zip code:
Home Phone:
Work or Cell Phone:
Email Address:
Date of Birth:
Marital Status:
U.S. Citizen?
How did you hear about Slim and Tone?

List your last two employers:
Dates(month/year)	Company Name/Address	Salary	Position	Reason for Leaving
to
to

How will you be financing your investment?

Bank Loan Cash Small Business Loan Home Equity Loan Other

Do you plan to make Slim and Tone your full time job?

Yes No Maybe

What is your timeframe?

1 - 3 Months 4 - 6 Months 7 - 12 Months

Where would you like to open a Slim and Tone club:

First Priority:

Second Priority:

Thank you for providing this information.
Your Signature:
Today's Date:

Upon receipt of your application, a link providing you access to the Slim and Tone Uniform Franchise Offering Circular will be emailed to you.