Full Name:
Address:
City:
State:
– Select State –
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Connecticut
Delaware
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Hawaii
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Maryland
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South Carolina
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Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
Phone # (Home):
Phone # (Office):
Phone # (Cell):
Best Time To Call:
E-Mail Address
Fax #:
Spouse’s Name
No. of Dependents
If No, Name Country:
Educational History:
High School
College
Graduate
Degree:
Name of Last School Attended:
Please give present or last position first and provide the last 5 years of work/business history; attach an additional sheet if necessary.
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Company:
City, State:
Position:
Employed From:
To:
Major Accomplishments:
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Company:
City, State:
Position:
Employed From:
To:
Major Accomplishments:
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Company:
City, State:
Position:
Employed From:
To:
Major Accomplishments:
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If yes, please identify all partners:
Name
Address
Phone #
Active in Franchise?
Name
Address
Phone #
Active in Franchise?
Name
Address
Phone #
Active in Franchise?
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If yes, what type:
2. Have you ever failed in business, filed bankruptcy or compromised with creditors? If yes, please give details and include any remaining liabilities.
If Yes, elaborate:
4. Are there, or have there ever been, any lawsuits against you? If yes, explain:
5. Please tell us why you are looking for a business opportunity:
6. Where did you hear about Chef Creole?
7. What do you like about our business?
8. What does “franchising” mean to you?
9. In your opinion, how would you describe the roles of the Franchisor and Franchisee in a franchise system?
10. Do you understand that the success or failure of your business is primarily your responsibility? Please provide your comments.
11. What are your goals and objectives for the next 5 years?
12. There are some basic ingredients to every successful business. If you are awarded a franchise, what would you do to make it successful [please describe in detail]?
13. Please list 3 of your geographic preference for locations:
If Yes, indicate which markets (1)
(2)
PERSONAL REFERENCES
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Name
Phone #
Association
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Name
Phone #
Association
3 - - - - - - - - - - - - - - - - - - - -
Name
Phone #
Association
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How much of the franchise investment will come from your own capital?
What is your annual income requirement?
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Please provide the financial information set forth in the schedules on the next section:
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Yearly Income
Salary, Wages
Bonus, Commissions
Dividends, Interest
Other Income
Total Yearly Income
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Personal Balance Sheet
Assets
Cash
Marketable Securities
Non-Readily Marketable Securities
Net Cash Surrender Value of Life Insurance
Primary Residence Real Estate
Real Estate Investments
IRA, Profit Sharing, other Vested Retirement Accts
Deferred Income
Total Assets
Liabilities
Secured/Unsecured Notes Payable to others
Accounts Payable
Margin Accounts
Notes due: Partnership
Mortgage Debt
Life Insurance Loans
Other Liabilities
Total Liabilities
Total Net Worth
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In lieu of filling out the Personal Balance Sheet above, attach your most recent Financial Statement.
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Access to Capital
Letter of Credit Name
Amount
Bank Name
Amount
Family Name
Amount
Other Name
Amount
* Chef Creole Franchise Corp. reserves the right to request confirmation from parties named above to verify fund availability.
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Attach Resume, If Available.
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The information supplied by me/us on this application is true to the best of my/our knowledge.
Signature:
Date:
Signature:
Date:
In connection with this application for a franchise with Chef Creole Franchise Corp. (“Chef Creole”), Applicant(s) hereby authorizes Chef Creole or its agents, to contact any present or past employer, school, financial institution, law enforcement agency, reference or any other person, firm or corporation.
Applicant(s) authorize and request any of the firms or persons contacted to provide all information concerning them, and hereby release said firms, institutions and their agents and employees from all liability and responsibility for releasing this information. Applicant(s) understand such reports may contain information concerning their credit history or criminal history. Applicant(s) agrees to restrict the use of this information only to the evaluation of Applicant(s) application for a Chef Creole franchise. With respect to any credit report pertaining to Applicant(s) credit history that is obtained in connection with this application, the permission granted herein to obtain a copy of Applicant(s) credit report shall be on-going, should Applicant(s) become a Chef Creole franchisee, and shall relate to any legitimate purpose associated with Applicant(s) status as a Chef Creole franchisee.
Applicant(s) is willing and requests that a photocopy of this Authorization be accepted with the same authority as the original. Applicant(s) further authorizes Chef Creole Franchise Corp, or its agents, to release to prospective financial sources such financial and other information concerning Applicant(s) in their files as may be requested.
Notice: The federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, or age (provided the applicant has the capacity to enter into a binding contract); or because all or part of the applicant’s income derives from any public assistance program or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning creditors is the Federal Trade Commission, Equal Credit Opportunity, Washington, DC 20580.
WITH THIS AUTHORIZATION INCLUDE A COPY OF THE APPLICANT’S DRIVERS LICENSE AND SOCIAL SECURITY CARD (if no social security card is available, provide a copy of the first page of such person’s last filed tax return).
By signing below, Applicant(s) agrees to keep all Confidential Information disclosed by the Chef Creole Franchise, Corp. strictly confidential and shall not use any Confidential Information for any purpose other than to determine whether to proceed as a Chef Creole franchisee. Applicant(s) agrees to limit access to Confidential Information to its legal advisors and/or business consultants. Applicant(s) agree not reproduce or transcribe Confidential Information. The term “Confidential Information” means: (a) the Chef Creole Franchise Disclosure Document and exhibits; and (b) any information in written, electronic or other tangible form communicated that is identified as confidential or proprietary or that, based on its nature and the circumstances surrounding its disclosure or receipt, a reasonable person would understand is proprietary or confidential (including Chef Creole Franchise Corp’s franchise business, advertising and marketing strategies, geographical locations, vendors, contacts, and websites, and client lists).
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APPLICANT:
Signature:
Date:
Signature:
Date:
Submit