Franchise Opportunity Application Form

Personal Data
Mr. Mrs.
Ms. Miss
Single Married
Separated Divorced
Surname:
First Name & Initial:
Address:
(include address, City, Province, and Postal Code)
How long there?
Previous Address:
(include address, City, Province, and Postal Code)
How long there?
Spouse:
(include name, occupation and Employer)
Telephone (Home): (include Area Code)
Telephone (Business): (include Area Code)
Fax: (include Area Code)
Email:
Date of Birth: (MM/DD/YY)
Social Insurance Number:
(Optional now - required on approval)
Number of Dependants:
Spouse date of birth: (MM/DD/YY)
Spouse Social Insurance Number:
What is your present state of health:
Describe any physical disabilities or limitations:
Have you ever been convicted of a criminal offense?
Yes No
If yes, give particulars:
Are there any lawsuits, judgements or liens against you?
Yes No
If yes, give particulars:
Have you ever filed bankruptcy or ever failed in any business?
Yes No
If yes, give particulars:
Are you related to any employee, franchisee, Officer or Director of this company?
Yes No
If yes, give particulars:

Business & Employment History
Current Employer:  
Company Name:
Address:
(include address, City, Province, and
Postal Code)
Telephone: (include Area Code)
Supervisor:
Type of Business:
Job Position:
Annual Salary:
Description of Responsibilities
Employed from: to:

Previous Employer:  
Company Name:
Address:
(include address, City, Province, and
Postal Code)
Telephone: (include Area Code)
Supervisor:
Type of Business:
Job Position:
Annual Salary:
Description of Responsibilities
Employed from: to:

Other Business Interests
Have you ever had your own business or been self-employed?
Yes No
If yes, give particulars:
What other businesses have you investigated?
Have you been involved in any outside Companies or Directorships?
Have you been a member of any Civic, Business or Professional association?
Yes No
If yes, give particulars:
Have you had any previous work experience in the food industry?
Yes No
If yes, give particulars:

Education
Please indicate last year of school attended:

High School:
1. 2. 3. 4. 5.

University:
1. 2. 3. 4. 5.
Name of last school attended:
Degree(s) Achieved:
What other course(s) or training (please list)
Other:
Are you currently enrolled in any continuing education courses?
Yes No
If yes, give particulars:
Do you have any computer experience whatsoever?
Yes No
If yes, give particulars:

Financial Information
Personal Income (Annually)  
Salary or Wages: $
Bonuses: $
Dividends or Interest: $
Spouse's Income: $
Other Income: (describe)
TOTAL INCOME: $
What is the amount of cash investment you can personally commit to your business? (please list sources)

Source 1: $

Source 2: $
Source 3: $
Source 4: $
TOTAL CASH INVESTMENT: $
Assets  
Cash on hand and in bank(s): $
Securities & Stocks: $
Mutual Funds & RRSP's: $
Accounts Receivable: $
Principle Residence: (Market Value) $
Real Estate: (other) $
Receivable Mortgages: $
Insurance Cash Value: $
Personal Property: $
TOTAL Assets: $

Liabilities  
Accounts and Notes Payable: $
Unpaid Income Taxes: $
Other Unpaid Accounts: (describe)
Amounts Owing on Credit Card(s): $
Loans on Life Insurance Policies: $
Real Estate Mortgage Payable: $
Other Mortgages and liens payable: $
Other Debts: (Describe)
TOTAL Liabilities: $

Total Assets: $
Less Total Liabilities $
NET WORTH: $

Real Estate
Description of Property:    
1. 2. 3.

Date of Acquisition:		    
1. 2. 3.

Title in Name(s) of:		    
1. 2. 3.

Purchase Price:		    
1. $ 2. $ 3. $

Current Market Value:		    
1. $ 2. $ 3. $

Amount of Mortgage:		    
1. $ 2. $ 3. $

Lending Institution:		    
1. 2. 3.

Additional Information
Will you require assistance to obtain any financing to purchase this franchise?
Yes No
Are you a partner or investor in any other business venture?
Yes No
If yes, give particulars:
Would this business be owned by yourself?
Yes No
Would this business be owned by yourself and a partner(s) or any investor(s)?
Yes No
I understand that any associates who will co-operate with me in financing this operation must also complete a financial profile.
Forms may be sent to:
Name of Partner or Investor:
Address:
Will any partner(s) or Investor(s) be active in the franchise?
Yes No
How much capital if any would you have to borrow? $
If we select each other, my involvement would be:
Full-time-operator:
Yes No
Husband/Wife Operator:
Yes No
Part-time with other business interests:
Yes No
Absentee operator (Investment only):
Yes No
Would you be willing to re-locate?
Yes No
Franchise location areas in order of preferences:
1.
2.
3.
When will you be able to start this franchise adventure?
Do you take any medication for any illness or condition?
Yes No
Are there any medical or other reasons you could not wear a complete uniform or carry out all daily functions of operating a Pita Pazzaz restaurant?
Yes No
If yes, please explain:
Do you currently know any Pita Pazzaz Franchisees or Corporate Personnel?
Yes No
If so, whom?
How did you become interested
in Pita Pazzaz?
If granted a Pita Pazzaz Franchise, would it be your only source of income?
Yes No
If no, please specify:
How many hours per week do you expect to work at your store?
Would you classify yourself as more "Management" or "Hands on Oriented"?
Management Hands-on
What day to day functions would you enjoy the most?

To what extent do you feel that “selling or introducing” the menu would increase your restaurant sales?

Not at all 10% 20% 30% 40% 50% Above 50%
Please Explain:

Banking Information
Personal Bank(s): Bank 1 Bank 2
Bank Name:
Account Number(s):
Contact:
Address:
(include address, City, Province, and Postal Code)
Telephone: (include Area Code)

Business Bank(s): Bank 1 Bank 2
Bank Name:
Account Number(s):
Contact:
Address:
(include address, City, Province, and Postal Code)
Telephone: (include Area Code)

References
Personal References:
  Name: Address:
(include address, City, Province, and P.C.)		 Telephone:
(include Area Code)
1.
2.
3.

Credit References:
  Name: Address:
(include address, City, Province, and P.C.)		 Telephone:
(include Area Code)
1.
2.
3.

Business References:
  Name: Address:
(include address, City, Province, and P.C.)		 Telephone:
(include Area Code)
1.
2.
3.

Comments
Please use this space provided to tell us anything else which you think is relevant, such as family business history, your personal business objectives, how many locations you would like to own, tax considerations, outstanding business ventures in which you participate, etc. Describe the extent and nature of any previous experience with the restaurant business and why you feel you would be a successful Franchisee.


Assessment Interview
1. How do you feel your operations as a franchisee affects the other franchisees in the system?

2.

How do you feel your performance as a franchisee affects the growth of the franchise chain?



3.

Do you think that business is a reflection of who you are as a person?

Yes No Explain:

4. What is meant by the statement "A franchisor is a supporter not a savior"?

5. List 5 things that you would consider "Good Customer Service".

6.

As a business owner, what factors are most important? (choose only 2)

Financial Security
Independence
Pride in Accomplishments
Feel Part of Team
Other:
7. How much money do you think you will earn from this franchise annually?

$
8. Realistically, how much money would you like to earn annually?

$

I hereby Certify...
I hereby certify that the information set forth above is true and correct to the best of my knowledge. I agree to notify Pita Pazzaz Inc. immediately of any material change in such information.

I hereby consent to Pita Pazzaz Inc. obtaining a Consumer Credit report in connection with this Franchise Application Form. I hereby further consent to Pita Pazzaz Inc. taking whatever action it considers necessary to verify the information set forth above including contacting any of the references listed.

I understand that Pita Pazzaz Inc. will keep all information concerning this Franchise Application Form confidential save and accept as may be presented to a banking or loans institution.

I agree that all information relating to the methods of operating as well as all building plans, equipment lists, details of equipment and supplies, identification of preferred suppliers, cost and profit information and other information relating to the business interest of Pita Pazzaz Inc. which has been or otherwise will be revealed to me in connection with my application for a Pita Pazzaz Franchise is a trade secret, property and/or confidence, and I shall not discuss with others or use for my own benefit of third parties any such information without the written consent of Pita Pazzaz Inc.

I further agree that all written material, drawings, instructions or documents of any type, which I receive from Pita Pazzaz Inc. shall remain the property of Pita Pazzaz Inc. and such documents are understood to be loaned for limited purposes only. Also, such documents may not be reproduced in whole or part and shall be returned to Pita Pazzaz Inc. upon request and in any event upon completion of the use for which loaned.

It is agreed that I shall not contest or deny the validity of Pita Pazzaz Inc. trademarks or trade name rights or other marks used by Pita Pazzaz Inc. or marks confusingly similar thereto, and I shall not use any such marks except under a Franchise Agreement.