Name *
E-Mail *
Home or CellPhone: *
Address: *
City: *
State: *
Zip: *
Country: *
Do You Rent or Own: * Rent Own
How long at this address?:
Current Occupation: *
How long at this occupation: *
Education: *
Date of Birth: *
Have you every been convicted of a felony offense?: * Yes No
Marital Status: * Single Married Separated Divorced
If married, will your spouse participate in the business?: Yes No
SPOUSE/PARTNER INFORMATION (if applicable)
Name:
Current Occupation:
How long at current occupation:
Annual income:
Business Experience / Employment History
Company 1 * (If self employed, type "Self"): *
Start Date: *
End Date: *
Position: *
Annual Income: *
Company 2:
Start Date:
End Date:
Position:
Annual income:
Company 3:
Start date:
End date:
Position:
Annual income:
Company 4:
Start date:
End date:
Position:
Annual income
Business / Management Goals & Objectives
Is your objective to (Check all that apply): * Supplement Transition Replace Your Current Income Invest Be Actively Involved
Specify the cities or areas and state you are interested in: *
Why are you interested in the restaurant industry?: *
How long have you been looking at business opportunities?: *
What other types of businesses are you considering?: *
How did you hear about The Waffle Experience?: *
What specifically about The Waffle Experience appeals to you?: *
On a scale of 1 - 10, with 10 being the highest, how committed are you to owning your own business?: *
What is your timeline for starting your own business? (In months): *
Why do you believe you can successfully operate & manage The Waffle Experience franchise opportunity?: *
Cash in Checking Account:
Cash in Savings Account:
Real Estate (Home Value):
Other Real Estate:
Cash Surrender in Life Insurance
Qualified Plan Assets / 401K Assets:
Qualified Plan Assets / IRA Assets:
Qualified Plan Assets / Other Assets:
Total Assets: *
LIABILITIES
Notes Payable to Banks:
Notes Payable to Finance Companies:
Real Estate Mortgage Indebtedness:
Credit Cards:
Other Liabilities:
Total Liabilities: *
NET WORTH (Total Assets minus Total Liabilities): *
What amount of money do you feel comfortable investing?: *
What is your liquid capital?: *
Have you ever filed for bankruptcy? If Yes, Please fill in the next section and explain: * Yes No
If "Yes", please explain here:
On a scale of 1 - 10, with 10 being the highest, how committed are you to moving forward with The Waffle Experience: *
Disclosure Statement
I understand the information I am receiving from The Waffle Experience or from a The Waffle Experience employee, agent, franchise, licensee or any of their affiliates is considered highly confidential. This material, concept and business model has been developed with a great deal of effort and expense to The Waffle Experience and is being made available to me because of my request and will be kept in strict confidence. I will not divulge or use any data, customer or employee names, addresses, techniques, methods, advertising materials, forms or any other information of any kind used in connection with The Waffle Experience without their consent. *
Please, enter your name (which will serve as your signature): *
Please enter today’s date: *