Personal Information: (personal and confidential)
In order for Chicken Kitchen to commence processing your application for franchise approval, you must complete the following questionnaire in its entirety, and have each investor/partner fill out a separate franchise application.

Your First & Last Name (required)

Your Email (required)

Your Phone Number (required)

Street Address (required)

City (required)

State (required)

Zip Code (required)

Country (required)

Social Security Number

Do you own or rent your home? (required)
OwnRent

How long have you lived at your current residence? (required)

If renting, name and phone number of landlord

Former residence

How long?

Date of birth

Height

Weight

Marital Status

Number of children

Number of dependents

Spouse's name

Spouse's Social Security

Spouse's occupation

Spouse's citizenship

Languages spoken fluently

Education level

Degrees

Major

Your degree last earned

Are you a citizen of the U.S.A?
YesNo

If no, which country?

Immigrant status in the U.S.A?

Alien number

Memberships in professional or civic organizations

Personal interests and hobbies

Describe any physical disabilities or limitations

Community involvement

Are you, or a business entity owned or controlled by you currently involved in any lawsuits or any other legal actions, either as plaintiff or defendant?
YesNo
If yes, please state date and details

Have you ever been convicted of a felony or misdemeanor (other than a minor traffic violation)?
YesNo
If yes, please state date and details

Have you, or a business entity owned or controlled by you ever been involved in a bankruptcy?
YesNo
If yes, please state date and details

Personal and Bank References:
List three people who have known you at least 5 years (please do not include employees or relatives)

Name

Relationship

Phone

Years Known

Name

Relationship

Phone

Years Known

Name

Relationship

Phone

Years Known

Business Experience:

Present Position

Type of Business

Employer Name

Superior Name

Employer Phone

Annual Income

Spouse's Income

Employer Address

May we contact your present employer?
YesNo
If no, please state reason why

Describe duties, responsibilities and number of employees supervised

Employed from

Employed to

Previous Position

Type of Business

Employer Name

Superior Name

Employer Phone

Employer Address

May we contact your present employer?
YesNo
If no, please state reason why

Describe duties, responsibilities and number of employees supervised

Employed from

Employed to

Restaurant and Franchise Experience:

Have you ever worked in a restaurant?
YesNo
If yes, please give details

Name

Location

Have you ever owned or managed a restaurant?
YesNo
If yes, please give details

Name

Location

Have you ever owned or managed a small business?
YesNo
If yes, please give details

Name

Location

Have you ever owned or managed a franchise business?
YesNo
If yes, please give details

Name

Location

How did you learn of Chicken Kitchen?

What appeals to you the most about Chicken Kitchen?

Are you evaluating other business opportunities?
YesNo
If yes, please give details

Are you evaluating other restaurant opportunities?
YesNo
If yes, please give details

Are you evaluating other restaurant franchises?
YesNo
If yes, please give details

Are you evaluating other chicken franchises?
YesNo
If yes, please give details

Do you own any other businesses?
YesNo
If yes, please give details

Do you plan to devote full time to this business?
YesNo
If not, what amount of time weekly

Do you plan to have partners/co-owners in this venture?
YesNo
How many? If yes, please give their names and have each partner complete a separate franchise application form

Partner #1 Name

Partner #1 Address

Partner #1 Cash Contribution

Partner #1 Ownership %

Partner #2 Name

Partner #2 Address

Partner #2 Cash Contribution

Partner #2 Ownership %

Partner #3 Name

Partner #3 Address

Partner #3 Cash Contribution

Partner #3 Ownership %

Partner #4 Name

Partner #4 Address

Partner #4 Cash Contribution

Partner #4 Ownership %

Who will be the operating partner?

What percentage of the business will they own?

What percentage of the equity of the restaurant business will you own?

How will you finance this investment? Personal Funds:

Borrowed Funds:

What would be your source of borrowed funds?

Cash:

Partners:

Loan:

Collateral:

Will the Chicken Kitchen franchise be considered your primary source of income?
YesNo
If no, what is your other source of income?

Are you applying for a franchise as individual, Corporation, Limited Liability Company or partnership?

If Corporation or partnership include the copy of the Articles of Incorporation or Articles of Partnership

What is your Federal Employer Tax Identification Number?

What is your State Employer or Sales Tax Number?

Location Preferences:

Are you interested in a single franchise? If yes, please state specifics relating the city, county, state or a particular location you mat be interested in:
YesNo

First Choice

State

Second Choice

State

Third Choice

State

Are you interested in a Multi-Unit (min. 3 restaurants) Area Development Agreement? If yes, please state specifics relating to city, county, state or a particular location you may be interested in:
YesNo

First

State

Second

State

Third

State

If you wish to be considered as a franchise owner, please complete all the data requested on this franchise application, sign it, include your last three year's personal income tax returns and latest personal certified financial statement, along with a copy of your immigration status in the U.S.A., and return to Chicken Kitchen USA, LLC.

By submitting this application you expressly acknowledge and agree that all banks, financial institutions, persons, firms, corporations referred in the above, are authorized to provide Chicken Kitchen USA, LLC, and/or any of its employees, agents and representatives, all information concerning the applicant for the purpose of determining financial and other qualifications. Chicken Kitchen USA, LLC is authorized to obtain a current credit bureau report in connection with this franchise application and if the undersigned becomes a Chicken Kitchen franchisee, to obtain periodic credit reports.

Any material misrepresentations, furnished by the applicant in this franchise application or any other communication, shall be grounds by which Chicken Kitchen may immediately terminate any agreements executed by the undersigned and Chicken Kitchen USA, LLC.

By submitting this application you certify and affirm to the best of your knowledge, that the foregoing franchise application and statements are true, factual, current and accurate representation of your financial and operational qualifications and background, and shall constitute a continuing representation. You hold Chicken Kitchen USA, LLC harmless for any damages arising from the verification of the information contained herin.