General Information Full Legal Name: Social Security Number: Address: Previous Address: Home Phone: Business Phone: Mobile: Email: Date of Birth: Country of Citizenship: Place of Birth: Marital Status: Spouse or Partner s Name: Dependents & Ages (if applicable): Spouse s or Partner s Occupation: Education Level Institution Name Location Year Completed High School Degree College University Other Page 1
Business Experience From To Employer Name and Business Type Position Title & Responsibilities Financial Statement Assets Liabilities Liquid Assets [A] Current Liabilities [D] Cash in Hand and in Banks Loans payable to Banks Receivables Loans payable to Others Life Insurance Real Estate / Mortgages Stocks & Securities Leases Bonds & Certificates of Deposits Taxes / Assessments Other Other Total Liquid Assets Total Current Liabilities Non-Liquid Assets [B] Total Assets [E] Real Estate (Market Value) Add [A] [B] and [C] together: Business Interest(s) Other Total Non-Liquid Assets Personal Assets [C] Total Net Worth Motor Vehicles Subtract [D] from [E] Personal Effects Other Total Personal Assets Annual Sources of Income Salary Bonus / Commission Interest / Dividends Business Profits Real Estate Other Income Total Income: Page 2
Asset Verification Schedule Cash in Hand and in Banks Bank Name, City, State Bank Telephone Account Type Amount Total: Debtor Relation to Applicant Accounts and Loans Receivables Nature of Debt Date of Original Maturity Amount Monthly Payment Present Balance Address Property Type Date Acquired Cost Real Estate Original Mortgage Current Market Value Current Mortgage Balance Net Value Business Interest Business Name Description Type (LLC, Corp) Equity % Original Investment Market Value Lender Relation to Applicant Nature of Debt Loans and Accounts Payable Secured Maturity Yes/No Date Original Value Monthly Payment Current Balance Mortgage Payments Property Address Lender Loan Amount Maturity Date Monthly Payment Current Balance Page 3
1. How did you become interested in a Wing Box franchise and why? 2. Have you ever owned or had an interest in any operation within the food service industry? YES/NO If yes, please explain: 3. Have you ever had any other sales or services experience? If yes, please explain: 4. What would you consider to be your strengths in becoming a successful Wing Box Franchisee? 5. If accepted, how soon are you looking to open your Wing Box franchise? 6. What percent of the business will you own? % 8. Will you work in the business full time? YES / NO 8. Who will be responsible for the day-to-day operation of the business? 9. If married, will your spouse or partner be involved in the business? YES / NO If yes, how much involvement? 10. Will you have business partners or additional investors? YES / NO If yes, please provide name of each partner or investor: Page 4
11. How will you finance your Wing Box franchise? Cash Loan What is the source of these funds: 12. Have you declared Bankruptcy? YES / NO If yes, explain: 13. Have you ever been convicted of a felony or misdemeanor (other than a minor traffic violation) or are currently involved in a criminal proceeding? If yes, explain: 14. Once your Wing Box franchise is open, what is your goals and objectives for the next 5 years? 15. Have you discussed this opportunity with any of our existing locations, franchisees or employees? YES / NO If yes, which location(s) and who did you speak with? 16. Please specify which geographic areas you are interested in by order of preference. Please include City and State: 1., 2., 3., 17. Please list any additional questions, comments or concerns that will help us evaluate your application: Page 5
Application Submittal Please forward your completed application form to: Wing Box, Inc. Attn: Franchise Dept. 2351 Sunset Blvd, Ste 170-765 Rocklin, CA 95765 Or send it in completed Adobe Acrobat PDF form to: franchise@wingbox.co Declaration and Acknowledgment I declare that all information provided in support of this Franchise Application Form is true and correct and I agree to update this information should any material change occur. I acknowledge that any statements or information given in support of this Franchise Application Form and later found by Wing Box, Inc. to be false or misleading, either deliberate or unintentionally, could result in the termination of any franchise agreement between Wing Box, Inc. and the Applicant. I acknowledge that no contractual relationship exists between Wing Box, Inc. and the Applicant in respect to this Franchise Application Form. Confidential Information I acknowledge that prior to signing any franchise documents, I may be provided with written and verbal confidential information (as defined below) about Wing Box, Inc. and the Wing Box franchise and I agree to keep such confidential information absolutely confidential at all times, and will not divulge any confidential information to any third person unless Wing Box, Inc. gives prior written approval. Confidential Information means any confidential or commercially sensitive or valuable information concerning the system of operation of Wing Box franchises and includes, but not limited to, the operations manual, price lists, products, services and menus, supplier lists, customer lists and client information, any financial information concerning Wing Box, Inc. or its subsidiaries and/or its Wing Box franchise, the mode of operation, methods, advertising, publicity, trade secrets, technical information, other intellectual property or any document on which the word confidential has been marked. My obligation under this clause will continue to be binding on me regardless of whether or not I decide to enter into a franchise agreement, except in relation to information which is or becomes generally available to the public. Consent By signing this Franchise Application Form, I consent to Wing Box, Inc. exchanging my personal information with person(s) I have named as references, previous employers, financial institutions and any other sources I have disclosed as references in this form. Date: SIGNATURE PRINT NAME Page 6