WaBa Grill Franchise Application

First *
Middle
Last *
Street 1 *
Street 2
City *
State *
Zip *
(mm/dd/yyyy)
Yes No
/
Financial Information
$
$
$
$
Have you ever filed for bankruptcy protection? * Yes No If Yes, when? (mm/dd/yyyy)
Have you ever been convicted of a felony? * Yes No
Yes No If No, what is your citizenship?
Are you or anyone in your immediate family a partner or owner of a restaurant or deli? * Yes No
Are you or anyone in your immediate family employed by a restaurant or deli? * Yes No
Are you or anyone in your immediate family currently under any form of non-competition agreement that limits your right to operate a business? * Yes No
1.
2.

By submitting this document, I hereby certify that the information supplied in this Franchisee Evaluation Form and other financial statements made by me are true and correct. I agree to have all information confirmed by one of your representatives and I authorize you to check references and conduct such additional credit checks as deemed necessary. I further understand that submission of this information does not obligate either of the parties to purchase or sell a franchise.