Franchise Request - Lefty's Cheesesteak

Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Date of Birth*

Years at current address?*

Best Time to Contact*

How long have you wanted to operate your own franchise?*

Are there any other franchise opportunities that you are looking into? If Yes, Which ones?

Present Employer?*

Title*

Date started at current employer?*

Employer Address*

Street Address Address Line 2 City State ZIP Code

Current annual salary*

Business Phone*

Hours worked per week?*

Brief description of responsibiltiies*

Have you previously ever been self employed?*

Have you ever owned, operated, or worked with any business that provides products or services similar to ours in the fast casual or food service business?*

How would you finance your franchise?*

Will you have a partner?*

How long can you support yourself and your family without making withdrawals from your business?*

Spouse income and / or other sources of income*

Will you be the owner operator of this business?*

Can you devote your full time to the business?*

What skills / experience do you have that will help you be successful in this business?*

If qualifed, when would you be ready to start your franchise business?*

Would this business be your sole source of income?*

Have you been approved for financing?*

Amount of cash on hand for investment ($)*

Marketable Securities ($)*

Accounts / Notes Receivable ($)*

Retirement Plans ($)*

Total Real Estate Holding ($)*

Personal Property ($)*

Business Holdings ($)*

Other Assets ($)*

Total Personal Assets ($)*

Your Total Net Worth ($)*

Lefty's City and State Preferences*

Have you ever signed a contract or non-competitor agreement that might limit or disqualify you from owning / operating a LEFTY'S franchise?*

Have you or any company you have owned or managed ever gone through bankruptcy or compromised a debt?*

Are you now, or have you ever been party to any lawsuit – either as defendant or plaintiff?*

Have you ever been convicted of a felony?*

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