Download SLICES PIZZA JOINT FRANCHISE APPLICATION

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? __________________________________________________________________________
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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]
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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 __________________________
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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 $ ______________
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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 $ ______________
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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.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
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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.
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