Concept
|
Advantages
|
Questions
|
Investment
|
Support
|
Application
Personal Information:
Contact Information:
First Name:
Last Name:
Primary Phone:
Location
Home
Business
Mobile
Alternate Phone:
Location
Home
Business
Mobile
Email Address:
Residence Address:
Street:
City:
State:
Zip:
Country:
Business Address:
Street:
City:
State:
Zip:
Country:
Personal Data:
Age:
Marital Status:
married
single
Spouse's Name:
No. of Children:
Ages:
Present Occupation:
Current Position:
How Long:
Education:
Highest Degree Achieved
Some High School
High School Graduate
Some College
Graduated College
Post Graduate
Franchise Information:
Do you own or have access to a real estate location suitable for a restaurant location?
Yes
No
Size:
Location:
If you don't have a real estate location, what area are you interested in? (city/state):
1st Choice:
2nd Choice:
3rd Choice:
Will you devote full time to this business?
Yes
No
If no, please explain:
Will your spouse be involved in this business?
Yes
No
Are you considering a partner?
Yes
No
If yes, who:
Total capital available to invest in a restaurant:
Have you ever been involved in bankruptcy?
Yes
No
If yes, when:
Are you currently involved in any lawsuits or legal actions?
Yes
No
If yes, please explain:
How did you learn of this franchise program?
Describe any training in sales, management retailing or food service:
Describe any experience which would help you to own a restauraunt:
Assets & Liabilities:
Assets
Amount
Cash on hand or in banks
$
U.S. Government Securities
$
Amounts and Loans Receivable
$
Notes Receivable, not discounted
$
Life insurance, Cash Surrender Value
$
Stocks, Bonds, Money Market
$
Real Estate
$
Automobiles
$
Other Assets (Itemize):
1.
$
2.
$
3.
$
Liabilities
Amount
Notes Payable to Bank
$
Notes Payable to others, unsecured
$
Loans against life insurance
$
Accounts Payable
$
Interest Payable
$
Taxes and Assessments
$
Mortgages Payable on Real Estate
$
Brokers margin accounts
$
Other Liabilities (Itemize):
1.
$
2.
$
3.
$
Income & Expenditures:
Annual Income
Amount
Salary (Exclude bonus)
$
Spouse's Salary (Exclude bonus)
$
Securities Income
$
Rentals
$
Commissions & Bonuses
$
Other Income (Itemize):
1.
$
2.
$
3.
$
Annual Expenditures
(Exclude ordinary living expenses)
Amount
Mortgage
$
Real Estate payment(s)
$
Rent
$
Income Taxes
$
Insurance Premiums
$
Other Expenditures (Include installment payments and other real estate):
1.
$
2.
$
3.
$
Credit References:
Name
Address
Account No.
Telephone
1.
2.
3.
4.
5.
Signature:
The "signature" below authorizes the release and verification of credit information to Ultimate Franchise Systems Inc.
Dated:
Name:
