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The Spaghetti Shop
8 Chimney View Lane
Springfield, Illinois 62707
Pages 1, 2 & 3
Complete

PERSONAL INFORMATION

Full Name Your Social Sec #
Spouses Name Spouses Social Sec #
Your Email Spouses Email
Your Age # of Children
Childrens Ages
Home Address City/State/Zip
Business Adddress City/State/Zip
Home Phone Business Phone
I wish to operate my business --  
As an owner operator As an owner investor With my spouse
With Children With a partner With a financial backer
I live in a --    
House Apartment Condominium
Own Rent  
Do you own property Yes No
Land Rental Property Other (please describe)
     

PARTNER OR FINANCIAL BACKER

Backers Name Backers Social Sec #
Home Address City/State/Zip
Home Phone Years Acquainted

EMPLOYMENT PROFILE

(List most recent position first. Indicate "A" for Applicant, "S" for Spouse)
A/S Employer    
City/State
  Position/Title From To Annual Income
A/S Employer    
City/State
  Position/Title From To Annual Income
A/S Employer    
City/State
  Position/Title From To Annual Income
A/S Employer    
City/State
  Position/Title From To Annual Income

ADDITIONAL INCOME

(List amounts received annually.)
Pension Interest
Real Estate Alimony
Other    

GEOGRAPHIC AREA OF INTEREST

(Please list where you would like to establish your business.)

1st Choice 2nd Choice 3rd Choice

EDUCATIONAL BACKGROUND

(Also list special talents.)

Yourself

Spouse

Where did you first hear about The Spaghetti Shop?

If newspaper, which one Which day of week?

FINANCIAL INFORMATION

(Please leave no questions unanswered, use "NO" or "NONE" where necessary.)

ASSETS

In Even $

LIABILITIES

In Even $

A01. L01.
A02. L02.
A03. L03.
A04. L04.
A05. L05.
A06. L06.
A07. L07.
A08. L08.
A09. L09.
A10. L10.
A11. L11.
A12. L12.
A13. L13.
A14. L14.
A15. L15.
A16. L16.
A17. L17.
A18. L18.
A19. TOTAL ASSETS --
A20. TOTAL LIABILITIES
TOTAL ASSETS NET WORTH

Approximate Net Worth
Total liquid capital readily available for investment $
From what source would this investment come?
How do you anticipate financing the balance?

PERSONAL INTERESTS

IS THERE ANYTHING ELSE YOU WOULD CARE TO AND WHICH MAY HELP US IN THE EVALUATION OF YOUR APPLICATION? INCLUDE FAMILY BACKGROUND, HOBBIES, AVOCATIONS, SPECIAL INTERESTS, MEMBERSHIP IN CIVIC SERVICE OR PROFESSIONAL ORGANIZATIONS, CONTINUING EDUCATION, LIFESTYLE, ETC.

I AM GOING INTO MY OWN BUSINESS BECAUSE . . .

I'm tired of working for someone else, I want to call the shots.
 I want to build financial security for myself and my family.
 I want to diversify my investments.
 I want to increase my income.
 Other (please explain)

I LIKE THE SPAGHETTI SHOP OPPORTUNITY BECAUSE . . .

The fast food industry is the leading source of francise business success.
 The Spaghetti Shop is a clearly unique and timely concept.
 Overall start-up investment requirement is much lower than other fast food opportunities.
 I am interested in the possibility of multiple locations.
 Other (please explain)

AT WHAT POINT DO YOU CONSIDER YOURSELF
IN PURCHASING THE SPAGHETTI SHOP?

Mildly Interested Very Interested Ready to Purchase

IF YOUR APPLICATION IS APPROVED,
WHEN WOULD YOU LIKE TO OPEN YOUR FIRST SPAGHETTI SHOP LOCATION?

30 days 60 days 90 days ASAP Other
Please use the space below to tell us about your personal goals and objectives in establishing a Spaghetti Shop franchise.
I understand that your receipt of this data neither obligates The Spaghetti Shop to offer, nor me to accept, any license or franchise agreement.

My electronic signature certifies that all information entered herein has been carefully read and is true, correct and complete. The undersigned authorizes The Spaghetti Shop or its agent to obtain verification of any of the above information and authorizes the release of such information to The Spaghetti Shop or its agent.
Signature:
Date: