Franchise Application Form

The following information is the basis for my franchise application. The submission of this application does not obligate Chronic Tacos or me in any way or manner. ( Please print or type requested. Additional paper should be attached if needed. )

If spouse or any other will be a co-owner, please complete an additional application.

all fields with a red asterick ( * ) are mandatory

Name:
	* Last	* First	Middle

* Address:

* Driver's License:

* Social Security No.:

Residence Telephone:
* Mobile Telephone:
Fax Number:
* Email:

Personal Information

* Date of Birth:		* Marital Status:
Spouse Name:		Spouse's Occupation:
Spouse's Date Of Birth:		Spouse's Social Security Number"	( Please call this in )
Number of Dependents:		Age of Dependants:
* Last former residence:
I am a citizen of:	*	I have permanent residence in:
My immigration status, if applicable, is:

Have you ever been convicted of a felony or misdemeanor or are such charges pending, being appealed, or are you under indictment? ( Do not include traffic violations )
YES NO

* Are you or your employer providing products, goods or services to Chronic Tacos or any of its franchises?
YES NO

* Have you ever been adjudicated bankrupt? YES NO

If you answered "yes" to any of the above, please provide details below:

Business Experience - Present Employment

* Company:
* Position:
* Address:
* Annual Salary:
* Employed from:	to
* Supervisor:
* Telephone:

* Describe duties, responsibilities and number of employees supervised:

* May we contact your present employer?	YES NO
* May we contact you at your business?	YES NO

Education

State your educational experience, including name and location of schools, years completed and degrees earned:

Business Interest

To what extent will you be actively involved in the day-to-day operations of the restaurant?

* What percent of the equity of this restaurant business will you own?	%
* What amount of cash will you personally invest in the franchise?	$

* What is the source of these funds?

* Will you have business partners?

YES NO

If you have a business partner, who will be the Operating Partner?

What is the total amount of cash your business partners will vest in this franchise?
$

Will any partner's interest in the franchise be encumbered in any way or subject to an agreement between partners? ( If so, please describe )

Will any person or entity other than the partners be entitled to receive, directly or indirectly, part of the profits from the operation of the restaurant? ( If so, please describe )

Please list business partners:

	Name	Estimated Net Worth	% of ownership	Proposed Cash Investment
1.
2.
3.
4.

* Do you currently have an interest in a fast food business or any other business ventures? ( If so, please describe )

* If you are approved for a Chronic Tacos franchise, will any partner be involved in any non-Chronic Tacos business activity? ( This includes all business activities, not just restaurants ) ( If so, please describe )

* Will the Operating Partner receive income from any source other than the restaurant? ( If so, please describe )

* What are your location preferences?