Untitled Document


		PERSONAL DATA:
* Name:
* Email Address:
Social Security No:
* Address:

* City:
* State:		Zip:
* Years There:
* Business Phone Number:
* Home Phone Number:
* Date of Birth:
* Marital Status:
Spouse's Name:
* Number of Dependents:
* How did you become aware of this franchise opportunity?

BUSINESS EXPERIENCE:
(Please list company name, type of business, position held, dates position held, and your most significant accomplishments.)
* Present / Most Recent Position:
* Previous Position:
* Previous Position:
* Have you ever owned a business?		YES NO
If yes, what type?
Other business affiliations (officer, director, partner, etc.)
* Do you have prior restaurant management experience?		YES NO
* Do you plan to devote full-time to this business venture?		YES NO
* Will your spouse be active in this venture?		YES NO
* Do you plan to have equity partners?		YES NO
If yes, please identify all partners:
NAME	ADDRESS	PHONE NUMBER	ACTIVE IN FRANCHISE
			YES NO
			YES NO
			YES NO
* Number of units planned: Year 1-2		Year 3-4	Year 5-6
* Location Preference:
* Second Choice Location Preference:

PRELIMINARY FINANCIAL DISCLOSURE:
* Assets:
* Liabilities:
* Net Worth:
* Unencumbered Liquid Assets Available:
* Equity in Personal Residence:
* Equity in Other Real Estate:

OTHER INFORMATION:
* Why do you feel you can successfully operate a Schoop's Franchise?
* How will the Schoop's Franchise opportunity help you in acheiving your business and personal goals?
* Additional information or comments that you might like to share with us in evaluating your Request for Consideration?
* Confirmation Code:		Code = 3RT8N