Franchise Request Form

Personal Details

All fields with (*) are required.

Where did you hear about the Mustard franchise?

First Name*:

Last Name*:

Address*:

Address2:

City*:

State*:

Zip Code*:

Primary Telephone*:

Fax:

Email Address*:

Citizen of:

Date of Birth*:

Tax ID/SSN*:

Gender: Female Male

Are you of legal age in your Residence Area?

Yes No

Have you ever been convicted of a felony?
Yes No

Have you been involved in any litigation proceeding within the last 5 years? (If yes, additional information will be required at the time of sale)
Yes No

Spouse Personal Details

First Name:

Last Name:

Primary Telephone:

Email Address:

Citizen of:

Date of Birth:

Tax ID/SSN:

Gender: Female Male

Are you of legal age in your Residence Area?

Yes No

Have you ever been convicted of a felony?
Yes No

Have you been involved in any litigation proceeding within the last 5 years? (If yes, additional information will be required at the time of sale)
Yes No

Education Background

Highest Education Level*:

School Attended*:

Years*:

Grade/Degree Attained*:

School Attended:

Years:

Grade/Degree Attained:

School Attended:

Years:

Grade/Degree Attained:

Business Details

Employer*:

Number of Years*:

Nature of Business*:

Title*:

Describe Position:

Address*:

Address2:

City*:

State*:

Zip Code*:

Business Telephone:

Alternate Telephone:

Experience Level:

May we contact you at work?
Yes No

Financial Details

Occupation Income*: /year

Other Income: /year

Please explain other income :

Personal Bank*:

Branch*:

Address*:

Personal Bank:

Branch:

Address:

Individual Liquid Assets: (Cash, Stocks, etc.)

Individual Fixed Assets: (Home, Car, etc.)

Individual Total Assets:

Individual Liabilities: (Mortgages, Loans, etc.)

Your Individual
Total Net Worth

Would this business be your sole income source?
Yes No

Is there other financing not included above?
Yes No

If yes, how much financing is available?

References

Full Name*:

Address*:

Telephone*:

Full Name*:

Address*:

Telephone*:

Full Name*:

Address*:

Telephone*:

Partners

(All partners should fill out a separate Application)

Will you have partner(s)?
If not, you may skip this section. Otherwise please complete all relevant sections below. Yes No

First Name:

Last Name:

Ownership Percentage:

Active Silent

Male Female

First Name:

Last Name:

Ownership Percentage:

Active Silent

Male Female

First Name:

Last Name:

Ownership Percentage:

Active Silent

Male Female

First Name:

Last Name:

Ownership Percentage:

Active Silent

Male Female

To include a partner's financial information, ensure they complete a separate Application for Additional Information

Restaurant Operations

If qualified, when will you invest in a franchise?

How involved will you be in operating the restaurant?

Preferred Geographic Franchise Area

First Preference:

Second Preference:

Estimated training date should you choose to invest:

Disclaimer

I understand that the granting of a franchise is at the sole discretion of the Franchiser (Mustard Franchise Corporation).

I understand that any information I receive from the Franchiser or from any employee, agent or franchisee of the Franchiser is highly confidential ("Confidential Information"), has been developed with a great deal of effort and expense to the Franchiser, and is being made available to me solely because of this Application. I agree that I shall treat and maintain all Confidential Information as confidential, and I shall not, at any time, without the express written consent of the Franchiser, disclose, publish, or divulge any Confidential Information to any person, firm, corporation or other entity, or use any Confidential Information, directly or indirectly, for my own benefit or the benefit of any person, firm, corporation or other entity, other than for the benefit of the Franchiser.

Everything that I have stated in this application is true and I understand that the information provided by me will be relied upon by the Franchiser. I read, understand, and agree to all of the above.

Signatures

I have read the above disclaimer.*

Type name to indicate consent. Signature required at time of sale.

Applicant's Typed Name*:

Spouse's Typed Name:

Today's Date*: