CHILI SHACK FRANCHISE APPLICATION
NAME
___________________________________
____________________________________ ____________Last First MI.
SS#________________________________ Driver’s license # ___________________________
Address ___________________________________________________________________ How Long? _______________
Residence: Own ____ Rent____
Previous Address __________________________________________________________ How Long? _______
Home Phone ___________________ Bus. Phone ____________________ May we contact you at work? ______
Do you have a Partner or Co-Applicant? Yes___ No ___ Name______________________________________
(CO-APPLICANT MUST FILL OUT A SEPARATE APPLICATION)
Marital Status: Married_____ Single _____ Divorce _____
Spouses’ Name __________________________________________ SS# _______________________________
Dependents & ages:__________________________________________________________________________
U.S. Citizen _______ Registered Alien ________
EMPLOYMENT HISTORY
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DATES FROM TO COMPANY & ADDRESS TITLE & DUTIES |
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EDUCATIONAL HISTORY
DATES FROM TO SCHOOL AREA OF STUDY DEGREE
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FINANCIAL INFORMATION
ARE YOU APPLYING AS A(N) INDIVIDUAL, PARTNERSHIP, OR CORPORATION? IF YOU ARE APPLYING AS A PARTNERSHIP, PLEASE INCLUDE INDIVIDUAL COPIES OF THIS APPLICATION COMPLETED BY EACH PARTNER.
IF YOU ARE APPLYING AS A CORPORATION, PLEASE INCLUDE AN UPDATED FINANCIAL STATEMENT WITH THE APPLICATION.
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ASSETS
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In Dollars(Omit cents)
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LIABILITIES |
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In Dollars |
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Cash on hand and in banks |
$ |
Notes payable to banks |
$
$ |
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U.S. Gov't. & Marketable Securities |
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Notes payable to other institutions |
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Non-Marketable Securities |
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Notes payable to individuals and others |
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Securities held by broker in margin counts |
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Due to brokers |
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Restricted or control stocks |
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Accounts and bills due |
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Real estate owned - |
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Unpaid income tax |
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Accounts, loans and other notes receivable |
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Other unpaid taxes and interest |
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Automobile -biles and other vehicles |
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Real estate mortgages payable - |
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Other personal property |
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Cash value - life insurance - |
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Other debts - itemize |
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Book value of business ventures - |
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Other assets - itemize |
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TOTAL ASSETS |
$ |
Total Liabilities
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$ _____________________
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$ |
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Net Worth $ _____________________ |
$ |
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Total Liabilities & Net Worth $ _____________________
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$ |
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Annul Income Information |
Annual Expenditures |
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For Year Ended 20_______ |
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Salary $ _________________ |
Mortgage/Rental $ ________________ |
______________________ $___________
Do you have any? Yes______ No ______ Amount _________________
Legal Actions Pending Yes____ No ____ Case #_____________ Name of Court______________________ Amt. of Dispute______________
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Spouse's Salary $_______________ $ |
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Bonus & commissions $ ______________
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Net real estate income $ _______________ |
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Other special debt or circumstances? ______
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________________ $ _____________ |
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________________ $ _____________ |
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________________ $ _____________ |
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Total Income $ _________________ |
Total Expenditures $ __________________ |
Total Contin. Liabilities $ ______________
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Income Tax settled through (Date).______________________
Have you ever declared Bankruptcy? Yes_____ No_____
If yes, please provide the following information: Case No. __________ Location of Court __________________________
Discharge received?_______________(Yes, No)
PERSONAL INFORMATION
How did you hear about the Chili Shack? ________________________________________________________
Will you operate and manage the Chili Shack on a full-time basis? Yes_____No____
If not, please explain who will be responsible for the day-to-day operations.
___________________________________________________________________________________________
___________________________________________________________________________________________
What geographical areas are you interested in?
1.____________________________________ 2. ______________________________________
3._____________________________________ 4._______________________________________
Do you have a specific location in mind?
When would you like to open your Chili Shack franchise business?
_________________________________________________________
How much personal capital are you prepared to invest in a Chili Shack Franchise:
____________________________________________________________________________________
How will you finance the remainder?
______________________________________________________
____________________________________________________________________________________
Do you plan to have investors or equity partners? _________________________________________________
If so, to what extent?_________________________________________________________________________
Have you ever owned a franchise? Yes______ No______
If yes, the name of the franchise organization.
____________________________________________________
What are your long-term business goals?
__________________________________________________________________________________________
__________________________________________________________________________________________
Why do you want to own your own business?
__________________________________________________________________________________________
__________________________________________________________________________________________
What attributes do you think you have that would contribute to your success as a Chili Shack franchisee
__________________________________________________________________________________________
____________________________________________________________________________________________________________
It is understood that the purpose of this Applications for general information. It is understood that the Chili Shack Franchise Company relies on the information provided in assessing the desirability and qualifications of the applicant . This is not a contract and thereby does not incur an obligation on either party. But the undersigned understands that misrepresentation or omission of facts is cause for termination by that the Chili Shack Franchise Company of any agreement entered into with that the Chili Shack Franchise Company
In order to make possible a full evaluation of the undersigned suitability to be come a Chili Shack Franchisee, the undersigned authorizes that the Chili Shack Franchise Company and its agents to perform for it any credit or background check on the undersigned which is deemed appropriate by that the Chili Shack Franchise Company and/or its agents.
APPLICANT’S SIGNATURE
________________________________________________________________ DATE:
___________________
________________________________________________________________ DATE __________________________