D.P. Dough Franchisee Information Form

BASIC INFORMATION

Date of Birth *

Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Home Phone

### - ### - ####

Cell Phone

### - ### - ####

Business Phone

### - ### - ####

Fax:

### - ### - ####

Email

Best number to contact you

Marital Status

Will spouse be active in business?

Spouse's Name

First Last

Spouse's Occupation

PERSONAL HISTORY

Are you a U.S. citizen? *

Yes

No

If no, please give place of permanent residence and your immigration status

Have you ever owned your own business? *

Yes

No

Details

Are you currently part to any pending legal action? *

Yes

No

If yes, state details

Have you ever been convicted of a felony, or a misdemeanor that was based upon perjury, fraud or theft? *

Yes

No

If yes, state details

Have you ever filed for bankruptcy? *

Yes

No

If yes, state details

EMPLOYMENT HISTORY

Company *

Type of business *

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Start Date

MM / DD / YYYY

End Date

MM / DD / YYYY

Position *

Annual salary

Supervisor

First Last

Supervisor's phone

### - ### - ####

Describe duties, responsibilities

Number of employees supervised

Company

Type of business

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Start Date

MM / DD / YYYY

End Date

MM / DD / YYYY

Position

Annual salary

Supervisor

Supervisor's phone

### - ### - ####

Describe duties, responsibilities

Number of employees supervised

EDUCATION HISTORY

Please state last year of education completed *

Did you graduate from high school? *

Yes

No

Did you graduate from college? *

Yes

No

Do you have any post-graduate education? If so, what is it?

What college or university did you attend?

HOW DO YOU KNOW ABOUT D.P. DOUGH?

I was referred

Yes

No

By whom?

I worked at a D.P. Dough

Yes

No

Which one?

I went to a college where there was a D.P. Dough

Yes

No

What college?

WHY DO YOU WANT TO FRANCHISE?

How would you describe the roles of the Franchiser and the Franchisee?

How did you become interested in the D.P. Dough Franchise and why?

Have you ever owned or had an ownership interest in any other operation within the food service industry?

Yes

No

Please give details

Who would be responsible for the day to day operations of your D.P. Dough franchise?

Do you have any experience in working for a late night delivery business?

Yes

No

Are you willing to work incredibly hard and put in long hours, especially at the early phases of the restaurant?

Yes

No

YOUR POTENTIAL D.P. DOUGH FRANCHISE

What percentage of the equity of the restaurant will you own?

Will you have a business partner?

Yes

No

Business partner's name

First Last

Involvement

Full Time

Part Time

Investment Only

Business partner's name

First Last

Involvement

Full Time

Part Time

Investment Only

Business partner's name

First Last

Involvement

Full Time

Part Time

Investment Only

What other businesses do you have an interest in?

How will you finance this business venture?

Cash

SBA Loan

Conventional Loan

Penalty/Tax Free Use of IRA

Gift from Friend/Family

Home Equity

Typically a $25,000 to $65,000 down payment is required to get a loan. How will you get that cash?

Cash on Hand

Penalty/Tax Free Use of IRA

Gift from Friend/Family

Home Equity

If loan, what collateral will be made available?

How much cash on hand do you have?

Up to $20,000

$20-50,000

Over $50,000

If you will use your IRA (penalty and tax free), how much do you have in an IRA?

If you will use a gift (not a loan) from a friend or family member, how much will they give you?

If you will use home equity, how much do you have access to (80% of the value of your house less the balance on the mortgage)?

If qualified, when would you be ready to invest in your Franchise?

WHERE WILL YOUR D.P. DOUGH RESTAURANT BE LOCATED?

First choice

Second choice

Are you open to other locations?

Do you have interest in multiple units?

Yes

No

If so, how many units are you interested in operating?

FINANCIAL STATEMENT AS OF DATE OF APPLICATION

Assets

Cash on hand

Securities (stocks, bonds, RRSPs)

Accounts and Loans Receivables

Home (market value)

Other Real Estate

Automobiles (market value)

Other Assets (please list)

Total Assets

Liabilities

Notes Payable

Loans against insurance

Loans

Mortgages (balance-owing)

Credit Cards

Other liabilities (please list)

Total Liabilities

NET WORTH

Net Worth (total assets - total liabilities) =

LEGAL

I hereby certify that to the best of my knowledge and belief, the answers given by me to the foregoing questions and all statements made by me in this application are correct. I hereby authorize D.P. Dough Franchising, LLC, or its agent, to verify any and all data submitted and to make any additional credit and financial investigation that it deems necessary or advisable.

I hereby further authorize D.P. Dough Franchising, LLC or its agent, to obtain background character information regarding me which it deems necessary or advisable.

I understand that any false information or consequential omission contained in this application would because for immediate termination of any subsequent agreement reached between D.P. Dough Franchising, LLC and myself.
If D.P. Dough Franchising, LLC chooses to perform a background check, I agree to execute any further documentation necessary to achieve said background check or credit report. D.P. Dough Franchising, LLC will provide you with all required information under the Fair Credit Reporting Act prior to completing or initiating any credit report or background check.

Yes

No