Franchise Opportunities

Confidential Franchise Application And Evaluation Form

Please complete the following "Confidential Franchise Application and Evaluation Form".

All of your information will be held in the strictest confidence and it is understood that neither party will be under any obligation to proceed.

I'm ready to apply

1Personal Info 2 Business History 3Financial Information 4 General Information

PERSONAL INFO

*required fields

How did you hear about us?

First Name *

Last Name *

Birthday (DD/MM/YYYY) *

Street 1 *

Street 2

City *

Province *

Postal Code *

Phone (Residence)

Phone (Cell) *

Social Insurance Number

Preferred Email Address *

Home Email Address

Work Email Address

Personal References

Personal Reference 1

Personal Reference 2

1 Personal Info 2 Business History 3Financial Information 4 General Information

BUSINESS HISTORY

Position 1

Job Position

From Date

To Date

Company Name

Company Address

Annual Salary

Position 2

Job Position

From Date

To Date

Company Name

Company Address

Annual Salary

Position 3

Job Position

From Date

To Date

Company Name

Company Address

Annual Salary

Business References

Business Reference 1

Business Reference 2

Back

1 Personal Info 2 Business History 3 Financial Information 4 General Information

FINANCIAL INFORMATION

Capital Available for Investments

Sources and Amounts of Additional Capital

Estimated Net Worth Statement

Cash on Hand and In Bank

Current Accounts Receivable

Stocks and Bonds

Value of Real Estate Owned

Household Furnishings and Automobile

Notes Receivable

Other Assets/Income

Description of Other Assets/Income

Total Assets

Accounts Payable

Bank Loans

Notes Payable

Mortgages Outstanding

Loans Against Insurance

Other Obligations or Liabilities

Total Liabilities

Net Worth

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1 Personal Info 2 Business History 3 Financial Information 4 General Information

GENERAL INFORMATION

Have you or any member of your family ever been affiliated with or employed at any Smitty's location?

If yes, please provide the details

Do you plan to personally operate the restaurant?

If you do not plan to operate the restaurant, please provide the name and business experience of your operating partner

Briefly outline experience in food service industry for yourself and your operating partner where applicable

What geographic area interests you?

Are you interested in developing a new Smitty's?

Are you interested in taking over an existing Smitty's location if available?

Have you ever been declined personal insurance?

Have you ever been convicted of a criminal offense?

Have you ever been bankrupt?

Have you ever had a bond application declined?

Are you now or have you been a plaintiff or a defendant in any type of litigation in the past three years?

If you answered yes to any of the five questions above, please supply an explanation.

Will your franchise be operated as a

If other individuals will participate, each participant must fill out a completed Franchise Application and Evaluation Form. Please provide the name, address, and telephone of each participant

Certification

I hereby certify that the information given in this application is true, correct and complete to the best of my knowledge and belief. I hereby consent to the use, collection and retention by Smitty's Canada Limited of my personal information contained in this application for the purpose of conducting background checks on me, including without limitation and assessing my suitability as a Smitty's franchisee.

Yes, I Consent.

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