General Information
Full Legal Name: Social Security Number:
Address: Previous Address:
Home Phone: Business Phone: Mobile:
Email:
Date of Birth: Place of Birth:
Country of Citizenship: Marital Status:
Spouse or Partner’s Name: Dependents & Ages (if applicable):
Spouse’s or Partner’s Occupation:
Education
Level Institution Name Location Year
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
Asset Verification Schedule
Cash in Hand and in Banks
Bank Name, City, State Bank Telephone Account Type Amount
$ $ $ $ $ Total: $
Accounts and Loans Receivables
Debtor Relation to
Applicant
Nature of Debt Date of Maturity Original Amount Monthly Payment Present Balance Real Estate Address Property Type Date Acquired Cost Original Mortgage Current Market Value Current Mortgage Balance Net Value Business Interest
Business Name Description Type (LLC, Corp) Equity % Original Investment
Market Value
Loans and Accounts Payable Lender Relation to Applicant Nature of Debt Secured Yes/No Maturity Date Original Value Monthly Payment Current Balance Mortgage Payments
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
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:
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: [email protected]
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
