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Menu
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Catering
Rent the Food Truck
Shop
Shop
Cart
Locations
Menu
Coupons
Catering
Rent the Food Truck
Shop
Shop
Cart
Locations
Menu
Coupons
Catering
Rent the Food Truck
Shop
Shop
Cart
Locations
ORDER ONLINE
ORDER ONLINE
Menu
Coupons
Catering
Rent the Food Truck
Shop
Shop
Cart
Locations
Menu
Coupons
Catering
Rent the Food Truck
Shop
Shop
Cart
Locations
ORDER ONLINE
ORDER ONLINE
FRANCHISE APPLICATION
I AM APPLYING FOR
A single store franchise
*
Desired location of Store
*
How did you become interested in Chicken Shack Inc.?
*
PERSONAL INFORMATION
First Name
*
Last Name
*
Middle
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Length at Current Address
*
Phone
*
Cell Phone
Date of Birth
*
Date Format: MM slash DD slash YYYY
Citizenship
Social Security Number
*
Driver's License Number
*
Number of Dependents
*
Ages
*
Estimated minimum income required for your current living expenses:
*
Have you ever?
*
Filed bankruptcy?
Had a real estate loan foreclosed?
Been party to a lawsuit?
Had any other legal action taken against you?
Been convicted of a felony?
None of Above
If yes on any, please explain:
EMPLOYMENT
Company Name
*
City
*
Position Employed From/To
*
Income
*
Have you or your spouse ever owned, operated, or managed a restaurant?
*
Yes
No
If yes, explain
Have you ever owned or do you own an independent business?
*
Yes
No
If yes, explain
C O N F I D E N T I A L
Personal Financial Statement
ASSETS
For the following section, list the amount in dollars for each of the following assets.
Note: If your application is being seriously considered you will be contacted for verification of the following information.
Checking account(s) balance
Savings account(s) certificate(s) balance
U.S. Government securities
Listed securities
Unlisted securities
Accounts and notes receivable
Real Estate owned (home)
Real Estate owned (other)
Automobiles and other personal property
Income Tax Refund Due
Other assets (readily convertible to cash – list)
TOTAL ASSETS
*
Liabilities
For the following section, list the amount in dollars for each of the following liabilities.
Note: If your application is being seriously considered you will be contacted for verification of the following information.
Charge account(s) balance(s)
Notes payable to banks secured
Notes payable to banks unsecured
Notes payable to relatives
Notes payable to others
Accounts and bills due
Unpaid income tax
Other unpaid income taxes and interest
Real estate mortgages payable (home)
Real estate mortgages payable (other)
Other liens payable
Other debts – Itemize
Total liabilities
*
TOTAL LIABILITIES FROM TOTAL ASSETS = $ _____ NET WORTH
*
I certify all information is true and represents an accurate financial condition for the undersigned as of:
Date
*
Signature (Type Full Name)
*
Education
High School
Institution Name
*
City, State
*
Last Year Completed
*
Major
*
Degree
*
College
Institution Name
City, State
Last Year Completed
Major
Degree
Other
Institution Name
City, State
Last Year Completed
Major
Degree
Franchise ownership application:
Type of ownership:
*
Sole Proprietorship
Legal Partnership
Corporation
The entity name will be
*
Do you intend to operate and manage this business yourself?
*
Yes
No
Names of share holders or partners and their percentage (%) of ownership:
Sobeck Enterprises Inc. does not guarantee the financial performance of any franchisee or store. The decision to become a Chicken Shack Inc. franchisee and to open a store(s) must be based on the franchisee’s independent research and analysis. Sobeck Enterprises Inc. is not liable for any representation made by a Sobeck Enterprises Inc. employee with respect to real estate, financial, operations or marketing performance. I hereby certify that all information contained herein is current within thirty (30) days and accurate to the best of my knowledge. I further give Sobeck Enterprises Inc. permission to obtain any business or personal credit or financial information regarding the store opening approval procedure.
Date
*
Signature (Type Full Name)
*
Authorization for File Disclosure
The undersigned authorizes Sobeck Enterprises Inc., on behalf of Chicken Shack Inc., to access his or her credit and/or public record profile. In order to access this information, Sobeck Enterprises Inc., will need your social security number, your current address, and a previous address if you have moved within the last year. “By my signature affixed hereto, I authorize the management of Sobeck Enterprises Inc., or its agents as assigned, to access and obtain information concerning my history from any credit reporting agency, any law enforcement agency retaining criminal arrests or conviction history, any state government retaining driving record history, and any local, state or federal body retaining litigation files.”
Name
*
First
Last
Social Security Number
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Previous address if lived at present address for less than one year:
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Date
*
Signature (Type Full Name)
*
