OSPECTIVE - PDF document

1 OSPECTIVE FRANCHISEE APPLIC TION E
OSPECTIVE FRANCHISEE APPLIC TION EAT SMART, BE HEALTHY!WaBa Grill Franchise Corporation13181 Crossroads Pkwy N#510City of Industry, CA 91746(5629089222.wabagrill.comPleasefaxompleapplicationthefaxnumber(562) Name:./Mrs./Ms.(cicleone)LastFirstMiddle Address: City State:Postal/ZipCode EmailAddress: T elephone: Home:( ) ork: Cell: ( Fax: ) .S.Citizen? not,eligibleusiness? NotU.S.Citizenwhat isourimmigrantnonimmigrantstatus? w did you learn of our organization? Check all that apply. Throughfriendwspaper(whichpaper?) Ate at WaBa GrillRadio(whichstation? Freeway Billboardsebsite(whichsite?) Other ospective FranchiseeApplication Thank you for inquiring about the WaBa Grillfranchise opportunity. Please complete the entire application. If an item does not apply to you, enter “N/A.” Attach additional pages if necessary. False or misleading statementson t

2 hisform are grounds for terminating the
hisform are grounds for terminating the application process and /or grounds for terminating the franchiseagreement, should you be granted one. This application form is not an employment contract or franchise agreement. Submitting this form does not obligate you or WaBa GrillFranchise Corporation in any way.This application form should be completed by an individual whose intention isto becomeWaBa Grill franchiseeWaBa Grillwill not release personal information you provide us to third parties without your written consent, absent court order or other legal process.PERSOAL (Pleasevidedocumentation) EDUCTION:fouryeardegreepreferred School NameLocation CourseStudy Y ears Completed DegDiploma College/Unersity HighSchool Other SPECIAL SKILLS,ABILITIES,ETC.:Languages: Whatyournatlanguage? Whatotherlanguagesspeak/write? EMPLYMENTANDUSINESSHISCompanyNameAddress: TelephoneNumber: Supervisor’sName: DescriptionDuties:DatesEmployed: From To: Reasonleaving: CompanyNameAddress: T

3 elephoneNumber: Supervisor’sNam
elephoneNumber: Supervisor’sName: DescriptionDuties:DatesEmployed: From To: Reasonleaving: nowor haveeverbeenlicensedoperatefranchise? describe: Areanylawsuitspendingagainstyou? yes,describe: yes,describe: Haveeverbeenarrested? yes,please explain: BUSINESS PLAN: CityTownwhichareinterested: thatareanotavailable,arethereotherareasinterePleaselist: Whenwillablestartthisbusiness? / / Howmanyhoursperweekwilldevotethisbusiness? PERSONALREFERENCES: Name Add r ess T elephone Number Relationship ANCIALTEMENT: 20 . Thisstatement(Please check one:)indvidualfinancialinformationThefinancialinformationspouseandrequire$700k $1 Million inliquidassets. Wewillrequireyou to completea moredetailedfinancialcheckwhich you must provide proof of the informationprovided(bank statements, paystub, stocks, tax returns).AssetsAmountLiabilitiesAmount Cashbanks Notespayablebank Realestate Realestateamountwed StocksandBonds Loanslifeinsurancepolicies

4 Accountsable Cassurendealu nsu uto
Accountsable Cassurendealu nsu uto 1 (yearand Otherliabilitiesdescribe $ uto 2 (yearand $ Otherassets(describ $ ASSETSLIABILITIESNETotalAssetsminusotal Liabilities) AnnualIncomeAmountAnnualExpendituesAmount Salarywages own (net)opertytaxesandassessments Salary orwages spouse (net) videndinte nta(gross ederalandstateincometaxes Realestatemortgagepayments (per year Businessincome(net) aymentscontracts(Othernotes) Otherincome(describe Estimatedvingexpenses $ Other INCOMEEXPENDITUREScurentlysoucefinancing?vingsAccount: muchcapitalableest? illusepersonalassetsfinancethisfranchise? CheckingAccount: Pleasexplain: filedbankruptcycompomiseddebtduringthepastenears? yes,pleasexplain.Attaadditionalsheets,necessar ourcashdepositsheldjointtenancy?No, withwhom? BankName: Phone: ess: City/State/Zip: WABA GRILL FRANCHISE CORPORATIONUTHORIZTIONANDRELEASE:As part of the application and appral process I understand that certain background iestigations may be conducted. I hereby authorize

5 dWABA GRILL FRANCHISE CORP(the"Compay")a
dWABA GRILL FRANCHISE CORP(the"Compay")agentcontractorprocureConsumerReportwhichcould include obtaining and/or erifying information rgarding credit orthiness, credit standing, credit capacitgeneral charactegeneralreputationpersonalcharacteristics. Thisreportmaycompliedwithinformationobtainedfromcreditureaus,court recordrepositories,departmentmotorehicles,pastpresentemploers,educationainstitutionernmentaoccupationlicensigistrationentities,usinesspersonalreferencesandothersource.I authorized lw enforcement and other gernment agencies to release to the Compa, or its agent or contractoxisting personalinformationgardingmyselfrelatthevictioncriminalact.authorizeallappropriatevidualcompanieinstitutionschoolernmentauthoritiesreleaserifyinformunderstandthatphotocothisauthorizationouldacceptedwiththesameauthorityastheoriginal.Name: ./Mrs./Ms.(cicleone)LastFirstMiddle viousName:(maiden,a.k.a.) ess: Phone Numbers:

6 Business: City/StateZip/ostalCod
Business: City/StateZip/ostalCode: FAX: ( ) vince: Country: Residence: SocialSecurityNumber: LicenseNumberandvince: DateBirth: / / MonthDayear Pleaselistcitiesstatesandcountriesesidenceorkandeducationthelasten(7)ears: Signatu Date: WaBa Grill Franchise Corp.will not release personal information you provie us to third parties without your written consent, absent court order or legal process. REQUIRED COMMENTS:Please use this space and any additional sheets to tell us anything else you think is relevant, such as family business history, your personal business objectives, and what your most significant contribution would be if you are granted a WaBa Grill franchise. Signatu Date: SpouseSignatu Date: TIFICTIONAIVER:certifythattheinformationvidedthisapplicationcompleteandcorunderstandthatalse misleadingstatementsthisformaregroundsterminatingtheapplicationprocess,and/orgroundsfor terminatingmyfranchise,shouldgranted one. PrintName: Signatu Date: FOROFFICEUSE Rece Dat