Franchise Application

PERSONAL INFORMATION

Name *

First

Middle

Last

Social Security Number *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Daytime Phone *

Evening Phone *

Email *

Birthplace *

Birth Date *

US CItizen *

Yes
No

Have you ever been convicted of a crime, other than a traffic violation, or have been refused bond or been involved in any legal action? *

Yes
No

Spouse’s Name

Children's Names and Ages

EDUCATION

Last Year Attended School *

Name of School *

Degree *

Are you involved in any civic, social, scholastic or fraternal organizations? Please tell us about them.

What hobbies or activities do you enjoy in your spare time? *

YOUR PERSONAL REFERENCES

Please list the name, relationship and daytime phone numbers of three personal references you have known for at least five years.

Reference 1

Name *

First

Last

Phone

Reference 2

Name *

First

Last

Phone

Reference 3

Name *

First

Last

Phone

YOUR BUSINESS INFORMATION

1. Your Most Recent Employer

Dates Employed: From / To *

Company Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Final Job Title *

Final Annual Compensation *

Name of Immediate Supervisor *

First

Last

May We Contact Them? *

Yes
No

Your Responsibilities

2. Your Previous Employer (Most Recent)

Dates Employed: From / To

Company Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Final Job Title

Final Annual Compensation

Name of Immediate Supervisor

First

Last

May We Contact Them?

Yes
No

Your Responsibilities

Other Businesses

Have you owned any other businesses not listed?

Yes
No

Have you had any previous restaurant experience?

Yes
No

Any other current business interests?

YOUR BUSINESS REFERENCES

Please list the name and daytime phone numbers of three business references you have known for the past five years.

Business Reference 1

Name *

First

Last

Phone

Business Reference 2

Name *

First

Last

Phone

Business Reference 3

Name *

First

Last

Phone

YOU AND THE CHEESE STEAK SHOP

How did you learn about The Cheese Steak Shop? *

Why do you want to be a franchise owner of a Cheese Steak Shop restaurant? *

Will you operate and manage your Cheese Steak Shop restaurant on a full time basis? *

Yes
No

If your application is approved, when would you like to open your Cheese Steak Shop? *

Where would you like your Cheese Steak Shop restaurant located? (Please list locations in order of preference)

Location 1

Location 2

Location 3

Are you willing to spend as much as four weeks attending our training class? *

Yes
No

How much capital are you prepared to invest in a Cheese Steak Shop restaurant?

How will you finance the remainder?

Name your financing sources and terms

YOUR FINANCIAL INFORMATION

Statement of financial Condition as of

ASSETS - CASH

Bank Name(s) and Amount *

Other Notes Receivable

Stocks, Bonds, Securities (itemize)

Real Estate (owned)

Automobiles

Other Personal Property

Life Insurance (cash value)

Other Assets (itemize)

Total Assets

LIABILITIES - NOTES PAYABLE

Bank Name(s)

Institution(s)

Estate Mortgages Payable

Accounts and Bills Due

Unpaid Taxes

Other Debts (itemize)

Life Insurance Loans

TOTAL LIABILITIES *

TOTAL NET WORTH *

Total Liabilities Less Assets

YOUR ANNUAL INCOME

Salary

Spouse’s Salary

Bonuses & Commissions

Interest & Dividends

Other Income (itemize)

TOTAL INCOME *

YOUR ANNUAL EXPENDITURES

Mortgage/Rent Payments

Utility Payments

Taxes

Insurance Payments

Other Expenditures

TOTAL EXPENDITURES *

YOUR AUTHORIZATION

I understand that any information that I have received from “One Cheese Steak Franchising, LLC” is being made available to me as a result of this application. It shall be held in the strictest confidence. My electronic signature below authorizes any bank, S&L, insurance company or other financial institution to release to “One Cheese Steak Franchising, LLC.” any and all information concerning my accounts, including deposits withdrawals or other financial transactions. I further authorize the release of any information regarding my character, credit standing or past employment. This authorization shall be valid for information up to the date hereof and for ninety days.

PERSONAL INFORMATION

EDUCATION

YOUR PERSONAL REFERENCES

Reference 1

Reference 2

Reference 3

YOUR BUSINESS INFORMATION

1. Your Most Recent Employer

2. Your Previous Employer (Most Recent)

Other Businesses

YOUR BUSINESS REFERENCES

Business Reference 1

Business Reference 2

Business Reference 3

YOU AND THE CHEESE STEAK SHOP

Where would you like your Cheese Steak Shop restaurant located? (Please list locations in order of preference)

YOUR FINANCIAL INFORMATION

ASSETS - CASH

LIABILITIES - NOTES PAYABLE

YOUR ANNUAL INCOME

YOUR ANNUAL EXPENDITURES

YOUR AUTHORIZATION

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