Please DO NOT use commas (,) or dollar signs ($) and all totals will calculate for you automatically.

ASSETS

Liquid Funds

Retirement

Non-Retirement Investments

Personal Property, Present Value

Other Assets: Rental Properties, Machinery/Equipment, Land, Accounts Receivable

LIABILITIES

Real Estate Mortgage (Primary Residence)

Other Liabilities: Rental Property Mortgage(s), Medical Bills, Accounts Payable, Amount Due for Judgements/Settlements

Total Liabilities

SOURCES OF INCOME FOR PRIOR YEAR ENDING DECEMBER 31

LEGAL HISTORY

*NOTE: A conviction does not automatically mean that you will not be offered a franchise. The nature of your conviction and how long ago are important. Give all the facts so that a decision can be properly made.

Please complete all fields unless otherwise declared.

RELEASE & AUTHORIZATION

I hereby authorize GNC Holdings, LLC to investigate my background and qualifications for purposes of evaluating my qualifications to be a GNC Franchise Operator. I understand that such investigation may include an investigative consumer report, as well as a general background search and an investigation in accordance with anti-terrorimd legislation, such as the USA Patriot Act and Executive Order 13224 enacted by the U.S. Government. I understand that these investigations may reveal information as to my creditworthiness, credit standing, credit capacity, character, general reputation, personal characteristics and mode of living. Accordingly, I voluntarily and knowingly authorize any present or past employer or supervisor, law enforcement agency, state or federal agency, credit bureau, collection agency, banking institution, private business, military branch or the National Personnel Records Center, and/or other persons to give records or information they may have concerning my loan balances, criminal history, and employment records or any other information requested, to GNC Holdings, LLC and/or its parent companies, subsidiaries or agents. I voluntarily and knowingly and unconditionally release any of the above-named agencies and/or individuals from any and all liability resulting from furnishing this information. I understand that upon written request, GNC will make available to me a complete and accurate disclosure of the nature and scope of the investigation requested, as well as a copy of a summary of my rights as a consumer under the Fair Credit Reporting Act. The information contained in this application is provided for the purpose of obtaining a franchise and/or maintaining credit with franchisor on behalf of the undersigned. I understand that, if I am approved to become a GNC Franchise Operator, GNC may rely on this authorization and have additional background checks conducted during and throughout the term of my Franchise Agreement without asking for my authorization again. The undersigned expressly agree(s) to notify franchisor immediately in writing of any material change in his/her/their financial condition. The undersigned certifies that each part of the application and financial statements hereof and the information inserted herein has been carefully read and is true and correct. The undersigned further acknowledges and agrees that the granting of a franchise is at the sole discretion of GNC Holdings, LLC and that the filing of this application does not obligate the applicant to purchase or GNC to sell a franchise or location. According to the Fair Credit Reporting Act, I am entitled to know if credit is denied because of information obtained from a consumer reporting agency. I will be so advised and given the name of the agency or source of information. A photocopy of this release will be valid as an original even though the said photocopy does not contain an original written signature.