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Name
*
First
Last
Email
*
Phone
*
Address
*
Street Address
Address Line 2
City
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District of Columbia
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U.S. Virgin Islands
Vermont
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West Virginia
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Date of Birth
*
MM slash DD slash YYYY
Years at current address?
*
Best Time to Contact
*
Anytime
8am – 12pm
12pm – 5pm
5pm – 11pm
How long have you wanted to operate your own franchise?
*
< 1 Year
2-5 Years
5+ Years
Are there any other franchise opportunities that you are looking into? If Yes, Which ones?
Present Employer?
*
Title
*
Date started at current employer?
*
MM slash DD slash YYYY
Employer Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Current annual salary
*
Business Phone
*
Hours worked per week?
*
Brief description of responsibiltiies
*
Have you previously ever been self employed?
*
Yes
No
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?
*
Yes
No
How would you finance your franchise?
*
Will you have a partner?
*
Yes
No
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?
*
Yes
No
Can you devote your full time to the business?
*
Yes
No
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?
*
Yes
No
Have you been approved for financing?
*
Yes
No
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?
*
Yes
No
Have you or any company you have owned or managed ever gone through bankruptcy or compromised a debt?
*
Yes
No
Are you now, or have you ever been party to any lawsuit – either as defendant or plaintiff?
*
Yes
No
Have you ever been convicted of a felony?
*
Yes
No
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