Franchise Form

Recommended by (if any):

Contact No. / Mobile

Email Address

Note: Completing this form does not place any obligation on the applicant to purchase or the franchisor to sell the franchise to the applicant. To expedite processing of your application,
please ensure that all the information is provided as requested. Where information is not available or applicable, please indicate accordingly. All information will be kept strictly confidential

Franchise Applicant’s Personal Particulars

Date of application: *

Full Name: *

Please insert your recent photograph here *

No file chosen

Street Address *

Apartment, suite, etc *

City *

State/Province *

ZIP / Postal Code *

Country *

Mobile Tel Number

Home Tel Number

Nationality / PR Status *

Sex *MaleFemale

Marital Status *

Educational Qualifications

Highest Educational Level *

Date Achieved *

Did you receive a degree from a University / College? *YesNo

Details of qualifications

Employment / Business History

(Please provide details of your employment status or business that you own)

1-Current

Employer / Business Owned *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Number

Position

Monthly Income

Date Joined

Date Left

Describe Duties

2-Previous

Employer or Other Business Owned: *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Last Position Held:

Monthly Income

Date Joined

Date Left

Reason For Leaving / Describe Duties

3-Previous

Employer or Other Business Owned:

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Last Position Held

Monthly Income

Date Joined

Date Left

Reason For Leaving / Describe Duties

General

Have you ever been employed by any of the divisions in Burger One? *YesNo

Have you ever been convicted of a criminal offence in any country? *YesNo

Have you suffered any major illnesses or accidents within the last five years? *YesNo

Have you ever voluntarily or involuntarily petitioned for bankruptcy? *YesNo

Are you or any of your immediate family members involved, directly or indirectly, in a similar convenience store business? *YesNo

If you have answered ‘yes’ to any of the following questions, please indicate the details in the space below:

Financial Statement

Average Monthly Income from present occupation / business: *

Other Income

Total Amount of Funds Available For The Franchise: *

Source of Funds

Assets

Individual Liquid Assets *

Amount ($) *

Individual Fixed Assets *

Amount ($) *

Individual Total Assets *

Amount ($) *

Individual Liabilities *

Amount ($) *

Your Individual Total Net Worth *

Amount ($) *

Is there other financing not included in (Your Individual Total Net Worth) above? *YesNo

If Yes, how much financing is available?

If qualified, when can you attend/start the full-time training? *Immediatewithin 3 months>3 months

How involved will you be in operating the Burger One store *0%50%100%

Other Information

Have you ever applied for any franchise before? *YesNo

If yes, please state details & year

How did you learn about Burger One franchise system? *

Why are you applying for the franchise? *

Why do you think you’ll make an ideal Burger One franchisee? *

How many family members, relatives, friends or employees, do you already have in mind to work in the store on a full-time basis? *

Name

Relationship To You

Current Job

Name

Relationship To You

Current Job

Name

Relationship To You

Current Job

Name

Relationship To You

Current Job

Note: You may wish to attach a separate sheet if any space in the form is insufficient and/or attach your resume.

No file chosen

Declaration

I do hereby represent that all of the above answers are true and complete to the best of my knowledge and belief. I recognize that Burger One is not in any way obligated to franchise a store to me because of our execution of this document. I acknowledge that any false statement on this application shall be considered sufficient cause to deny any further consideration or cause revocation of any signed agreement with Burger One. I understand that an inquiry regarding my character, general reputation, personal characteristics, financial background and general fitness for being a Burger One franchisee may be made as a result of this application. In addition, by signing below I release any and all former and / or present employers, and any other personal or business references, from any liability whatsoever in connection with Burger One attempts to investigate my background and determine my fitness to become a franchisee. I hereby authorise the release of any and all documents, records, and other information pertaining to me to Burger One. A copy of this authorization may be used in place of and shall be valid as the original. I understand that this application is considered active for 60 days from the date below. I understand that Burger One reserve the right to reject my application without assigning any reasons whatsoever. I confirm that I will immediately notify Burger One in writing of any changes to my personal data or any other information contained in this form. By completing this form, I consent to your collection, use and disclosure of my personal data for the purposes of evaluating the franchise application, and if my franchise application is approved, then for the further purposes of: (i) managing or terminating the franchise relationship; and (ii) conducting any other business or legal matters related (directly or indirectly) to the franchise relationship and/or operation of the Burger One store.

Applicant’s Initials *

Date *

Franchise Application Form

Franchise Applicant’s Personal Particulars

Educational Qualifications

Employment / Business History

General

Financial Statement

Assets

Other Information

Declaration

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