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SLICES PIZZA JOINT FRANCHISE APPLICATION _________________________________________________ Personal Data Name (First, Middle, Last) ____________________________________________________________ Social Security # ______________________________ Home Address: ________________________________________________________________________________ ________________________________________________________________________________ City, State, Zip: ________________________________________________________________________________ How long have you lived there? ______________________ Home Phone _____________________ Cell Phone ______________________ Email _______________________________ Business Phone __________________________ Fax ____________________________________ Date of Birth ___________________ Place of Birth ________________________ Marital Status ________________ Spouse’s Name __________________________ Spouse’s Occupation ______________________ Children Name Age Previous Address(es) in last ten years: Address (including city, state and zip code) How long? Are you a US Citizen? ____Yes ____ No If not, what Country? __________________________________________________________________________ Page 1 of 7 Personal References (Provide at Least Three) (1) Name: ______________________________________ Phone: ___________________________________ Email: ______________________________________ Home Address: ____________________________________________________________________________ ____________________________________________________________________________ City, State, Zip: ____________________________________________________________________________ (2) Name: ______________________________________ Phone: ___________________________________ Email: ______________________________________ Home Address: ____________________________________________________________________________ ____________________________________________________________________________ City, State, Zip: ____________________________________________________________________________ (3) Name: ______________________________________ Phone: ___________________________________ Email: ______________________________________ Home Address: ____________________________________________________________________________ ____________________________________________________________________________ City, State, Zip: ____________________________________________________________________________ Education High School ____________________________________________________________ Years Completed _______ Degree earned: ____________ Name of College_________________________________________________________ Years Completed _______ Degree earned: ____________ Name of College_________________________________________________________ Years Completed _______ Degree earned: ____________ Additional sales, management or retail training (including dates: _________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ [PLEASE ATTACH A SEPARATE SHEET IF NECESSARY TO COMPLETE THS SECTION] Page 2 of 7 Employment History for Last 10 Years (Beginning with the Most Recent) Company Name _____________________________________________ From ______________ to ___________ May we contact this employer? ___Yes ____ No Contact Name ______________________________________ Phone __________________________ Address _____________________________________________________________________________________ City, State, Zip ________________________________________________________________________________ Type of Business ____________________________________________ # of Employees Supervised___________ Describe Responsibilities ________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Company Name _____________________________________________ From ______________ to ___________ May we contact this employer? ___Yes ____ No Contact Name ______________________________________ Phone __________________________ Address _____________________________________________________________________________________ City, State, Zip ________________________________________________________________________________ Type of Business ____________________________________________ # of Employees Supervised___________ Describe Responsibilities ________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Company Name _____________________________________________ From ______________ to ___________ May we contact this employer? ___Yes ____ No Contact Name ______________________________________ Phone __________________________ Page 3 of 7 Address _____________________________________________________________________________________ City, State, Zip ________________________________________________________________________________ Type of Business ____________________________________________ # of Employees Supervised___________ Describe Responsibilities _______________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ [PLEASE ATTACH A SEPARATE SHEET IF NECESSARY TO COMPLETE THS SECTION] PERSONAL FINANCIAL STATEMENT Assets Cash on hand and in banks $ ______________ U.S. government securities $ ______________ Trade accounts and loans receivable $ ______________ Notes receivable – secured and unsecured $ ______________ Life insurance – cash surrender value $ ______________ Stocks and bonds – marketable and non-marketable $ ______________ Real estate $ ______________ Automobiles – market value $ ______________ Other assets, property or investments (itemize below) __________________________________________ $ ______________ __________________________________________ $ ______________ __________________________________________ $ ______________ __________________________________________ $ ______________ __________________________________________ $ ______________ __________________________________________ $ ______________ __________________________________________ $ ______________ __________________________________________ $ ______________ TOTAL ASSETS $ ______________ Annual Sources of Income Salary $ ______________ Bonus and commissions $ ______________ Page 4 of 7 Dividends and interest $ ______________ Real estate income $ ______________ Business profession income $ ______________ Other income (itemize below) __________________________________________ $ ______________ __________________________________________ $ ______________ __________________________________________ $ ______________ __________________________________________ $ ______________ TOTAL ANNUAL INCOME $ ______________ Liabilities Notes payable to banks – secured and unsecured $ ______________ Notes, loans, advances, accounts payable to others $ ______________ Credit card debt $ ______________ Loans against life insurance $ ______________ Property taxes and assessments payable $ ______________ Mortgages payable on real estate $ ______________ Liens on real estate $ ______________ Federal and state taxes on current income $ ______________ Other debts (itemize below) __________________________________________ $ ______________ __________________________________________ $ ______________ __________________________________________ $ ______________ __________________________________________ $ ______________ __________________________________________ $ ______________ __________________________________________ $ ______________ __________________________________________ $ ______________ __________________________________________ $ ______________ TOTAL LIABILITIES $ ______________ Net Worth Total assets $ ______________ Less total liabilities $ ______________ Net worth $ ______________ Page 5 of 7 Business Data How did you learn about the Slices Pizza Joint franchise program? _________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ Do you now operate or have you had experience in operating a retail business? ___Yes ____ No If yes, please explain. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Do you intend to devote yourself full-time to the day-to-day operation of a Slices Pizza Joint franchise? ___Yes ____ No. If not, provide explanation and details about your operating partner. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Have you (and, if applicable, any parties, officers directors or shareholders): been convicted or pled nolo contendre to a felony, subject to registration as a sex offender; subject to or convicted of any administrative, criminal or civil action alleging a violation of any franchise law; been found liable in any action alleging fraud, embezzlement, fraudulent conversion, restraint of trade, unfair or deceptive practices, misappropriation of property or comparable allegations? ___Yes ____ No. If yes, please explain. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Have you (and, if applicable, any partners, officers, directors or shareholders) ever been adjudged bankrupt or reorganized due to insolvency, or been a principal officer of any company or a partner in any partnership that was adjudged bankrupt or reorganized due to insolvency? ___Yes ____ No. If yes, explain on an additional information sheet. If yes, please explain. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Page 6 of 7 Is there anything else you think we should know? ___Yes ____ No. If yes, please explain. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Will your franchise investment come from your own capital? ___Yes ____ No Geographical Location Preference. First Choice ________________________________________________ Second Choice ______________________________________________ Third Choice ________________________________________________ Authorization for Release of Personal Information I hereby attest to the accuracy of the personal financial statements contained in this confidential application. I authorize BackBay Pizza Group LLC or its agents to verify the data submitted, to obtain a consumer credit report and to make such additional credit, background or character confirmations which it deems necessary or advisable. In connection with these financial and background investigations, I authorize BackBay Pizza Group LLC or its agents to contact present or past employers, schools, financial institutions, law enforcement agencies and any other person, firm, corporation or source. I authorize any such source to provide BackBay Pizza Group LLC or its agents any and all information concerning me, and I hereby release any such source and its agents and employees from all liability for providing this information. I understand such reports may contain information concerning my education, employment, work habits, character or skill, criminal and credit history. I authorize that a photocopy or facsimile of this document may be accepted with the same authority as the original. BackBay Pizza Group LLC agrees to maintain in a confidential manner and restrict the use of any information contained or obtained in connection with this application for a Slices Pizza Joint franchise. I authorize BackBay Pizza Group LLC to release to prospective financing sources any information concerning me that may be requested by them. Signature of applicant ______________________________________________ Date____________________________________________________________ After completing the entire application, please email and/or mail it to: BACKBAY PIZZA GROUP LLC th 11 East 6 Street Tempe, Arizona 85281 [email protected] (480)966-4681 APPLICATIONS THAT ARE NOT SIGNED CANNOT BE PROCESSED This is not a franchise offering. The franchise offering is made by prospectus only. Page 7 of 7