Contact ValuePest Corporate. Monroe North Carolina

Full Name*

(First, Middle, Last)

Phone*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Date of Birth*

Social Security Number (SSN)*

Do you have access to the funds needed to open a ValuePest.com franchise?*

Yes
No

Are you a defendant in any lawsuits or legal actions?*

Yes
No

Are you a veteran?*

Yes
No

Do you have pest control industry experience?*

Yes
No

Do you have a pest control license?*

Yes
No

Have you ever filed for bankruptcy or are you in the process of filing bankruptcy?*

Yes
No

Have you ever been convicted of a felony?*

Yes
No

Total assets*

Current Income*

Total Liabilities*

Your Estimated Net Worth*

(Total Assets plus Income minus your total liabilities)

Digital Signature

By typing your name above, you are acknowledging the following:

I, ____________________ hereby authorize ValuePest.com of America, Inc., ("VALUEPEST") upon the execution of this Request for Consideration and/or consent form, to investigate the information contained in my application, and other background information, for the sole purpose of obtaining information relevant to my qualifications as independent franchisee thereof. I understand that this means I may be subject of a 'consumer report' from an outside agency, which report may contain information about my creditworthiness, credit standing, credit capacity, character, police and criminal records, general reputation, personal characteristics and mode of living, whichever are applicable. By signing below, I authorize VALUEPEST to obtain or cause to be obtained, a consumer report upon receipt of this form or at any time during which I am a franchisee. I understand that inquires on this application, which ask for my address and date of birth, are for identification purposes only. I release VALUEPEST and / or its agents and any person or entity that provides information pursuant to this form any and all liabilities arising from any claims, lawsuits, or other actions in regard to the information obtained from any and all of the above referenced sources. I further agree that the giving of any false, misleading or incomplete information will be grounds for denial or termination. I agree to indemnify, defend and hold harmless VALUEPEST, its subsidiaries, affiliates, employees, agents and customers from and against any demands , claims, liability arising from the gathering and use of any information obtained from any and all of the above referenced sources. The above information is my true and complete legal name and all information is correct to the best of my knowledge.

Franchise Application