First
Last
Email
Name Of The Company Which Would Own This Franchise
Preferred Phone Number
Date of Birth
Citizenship United States Canadian Other
Marital Status Single Married Divorced Widowed
Spouse Name
No. Of Dependents
Are you or one of your partners currently working with one of Fransmart's Franchise Success Specialists? Yes No
If yes, please choose their name from the dropdown list Al Rowe Allison Lisiecki Bob McKay Christian Hathaway Dan Rowe John Moates Jolly Khabrani Joshua Kovacs Leslie Lautzenhiser Mark Treptow Paul Tran Ryan Durishin Whitney Myrus
Mailing Address
Mailing Address 2
Country United States Canada Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d’Ivoire Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong S.A.R., China Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Réunion Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Viet Nam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe
State / Province Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon Other
City
Zip Code
Concept Interest Artichoke Pizza Atomic Wings Black Seed Bagel Bryn + Danes Cafe Davignon Calexico Cauldron Ice Cream Curry Up Now Fala Bar Halal Guys Hopscotch Hummus and Pita Co Locali Mamouns Merzi Mexikosher Naugles Papaya King Pie Hole Pokeatery Rise Biscuits and Donuts Slapfish The Chickery ZPizza
When Would You Like To Schedule A Discovery Day Meeting? Immediately Within the next month 1-3 months Unsure
How Soon Do You Anticipate Your First Restaurant Opening? 6 months 1 year More than a year
Where Would You Like To Open Your Business?
What Other Areas Would You Be Willing To Consider?
Current Employer Name
Current Position
Current Employer Location
Still Employed Here? Yes No
Highest Level Of Education Completed High School\GED Attended College, did not graduate Bachelors Degree Masters Degree Doctorate
Will You Have Partners In This Venture? Yes No
Partner 1 - Name
Partner 1 - Email Address
Partner 1 - Ownership %
Partner 1 - Time %
Partner 2 - Name
Partner 2 - Email Address
Partner 2 - Ownership %
Partner 2 - Time %
Cash
Marketable Securities
Other Assets
State The Total Amount Of *Unencumbered Liquid Capital* That Is Readily Available To Invest In A Franchise
What is the amount of credit/debt you have readily available?
What is the source of this credit/debt?
How Do You Anticipate Financing The Balance Of The Total Initial Investment?
Have You Been Pre-Approved For Financing Options? Yes No N/A
Monthly Salary & Wages
Other Income
Secured Notes Payable To Others
Unsecured Notes Payable To Others
Accounts Payable
Taxes Payable
Mortgage Debt
Other Liabilities
Are you currently, or were you previously, a franchise owner? Yes No
Type Of Franchise Quick Serve Restaurant Fast Casual Restaurant Casual Dining Restaurant Hotel Gas Station Convenience Store Health/Fitness Retail/Services Other None
Name Of Franchise Applebees Benihana Bennigans Bertuccis BJs Restaurants Bob Evans Bonefish Grill Brio Tuscan Grille Buffalo Wild Wings Carrabas Italian Grill Charlie Browns Steakhouse Cheeburger Cheeburger Cheeseburger In Paradise Chevys Fresh Mex Chilis CiCis Pizza Cracker Barrel Dennys Friendlys Fuddruckers Golden Corral Hardees Hard Rock Cafe Hooters Houlihans IHOP Joes Crab Shack Johnny Carinos Johnny Rockets Logans Roadhouse Lone Star Steakhouse Longhorn Steakhouse Maggianos Little Italy McCormick and Schmicks Mortons O'Charleys Olive Garden On The Border Outback Steakhouse Perkins PF Changs Rainforest Cafe Red Hot and Blue Red Lobster Red Robin Romanos Macaroni Grill Ruby Tuesday Ruths Chris Steak House Shoneys Sizzler Texas Roadhouse TGI Fridays The Capital Grille The Cheesecake Factory Tony Romas Uno Chicago Grill Village Inn Waffle House Other
Name Of Franchise A&W Arbys Auntie Annes Baskin Robbins Ben and Jerrys Bojangles Burger King Carls Jr Checkers Churchs Chicken Cinnabon Cold Stone Creamery Culvers Dairy Queen Dippin Dots Dominos Dunkin Donuts Great American Cookie Company Haagen Dazs In-N-Out Burger Jack In The Box Jamba Juice KFC Krispy Kreme Little Ceasars Long John Silvers Marble Slab Creamery McDonalds Panda Express Papa Johns Philly Pretzel Factory Pinkberry Pizza Hut Planet Smoothie Popeyes Pretzel Time Rallys Ritas Sbarro Smoothie King Sonic Subway Sweet Frog Taco Bell Taco Del Mar Taco Johns TCBY Wendys Wetzels Pretzels Whataburger White Castle Wings To Go Wingstop Wolfgang Puck Express Zaxbys Other
Name Of Franchise 800 Degrees Au Bon Pain Baja Fresh Blaze Pizza Blimpie Boston Market Brueggers Bagels Burger 21 BurgerFi Cafe Rio Mexican Grill California Pizza Kitchen Captain Ds Charleys Grilled Subs ChickFilA Corner Bakery Cafe Cosi Del Taco Dickeys Barbecue Pit Einstein Bros Bagels El Pollo Loco Elevation Burger Famous Daves BBQ Fazolis Firehouse Subs Five Guys Freshii Jasons Deli Jersey Mikes Jimmy Johns La Madeleine Le Pain Quotidien Matchbox McAlisters Deli MOD Pizza Moes Southwest Grill Murphys Deli Nandos Newks Eatery Noodles and Company Panera Bread Papa Murphys Pei Wei Pie Five Pieology Pita Pit Pizza Rev Pollo Tropical Potbelly Sandwich Shop Qdoba Mexican Grill Quiznos Raising Canes Schlotzskys Shake Shack Smashburger Starbucks Steak N Shake Sweetgreen Swiss Chalet The Counter The Habit Burger Grill The Halal Guys Tim Hortons Tropical Smoothie Cafe Uncle Maddios Vapiano Which Wich Zoes Kitchen Zoup zpizza &pizza Other
Name Of Franchise Best Western Choice Hotels Comfort Inn Courtyard Crowne Plaza Days Inn DoubleTree EconoLodge Embassy Suites Extended Stay America Fairfield Inn and Suites Four Points Four Seasons Hotels Hampton Inn Hilton Holiday Inn Homewood Suites Howard Johnson Hyatt Intercontinental Kimpton Hotels La Quinta Marriott Motel 6 Quality Radisson Ramada Red Roof Inn Renaissance Hotels Residence Inn Ritz Carlton Sheraton Sofitel Hotels Springhill Suites Super 8 Waldorf Astoria Westin Wyndham Other
Name Of Franchise 76 Amoco BP Circle K Citgo Exxon Getty Gulf Kwik Trip Lukoil Mobil Phillips 66 Pilot QuickChek QuikTrip Shell Sunoco Texaco Valero Wawa Other
Name Of Franchise 7-11 Allsups Convenience Stores ampm Caseys General Stores CEFCO Chevron Convenient Food Mart CrossAmerica Partners Cumberland Farms Del Rio EZ Mart Stores Fas Mart GetGo Convenience Stores Hasty Market Husky Energy Inc Hy-Vee Jacksons Food Stores Kangaroo Express Kroger Kwik Fill Kwik Trip Loves Travel Shops MapCo Maverik Pilot Flying J QuickChek QuikTrip RaceTrac Royal Farms Sheetz Speedway Stewarts Shops SuperAmerica Tesoro TravelCenters of America Wawa Xtra Mart Other
Name Of Franchise 9Round Anytime Fitness Charter Fitness Crunch Curves CycleBar EnVie Fitness Fit4Mom Fitness Revolution Golds Gym GymGuyz KoKo FitClub LA Weight Loss Liberty Fitness Lucille Roberts Orangetheory Fitness Planet Fitness Pure Barre Retro Fitness Snap Fitness Tapout Fitness Title Boxing Club UFC Gym Yoga Fit Other
Name Of Franchise Aarons Ace Hardware Anago Cleaning Systems Bricks 4 Kidz Budget Blinds Inc Buildingstars CertaPro Painters ChemDry Carpet and Upholstery Cleaning CleanNet USA Comfort Keepers Cruise Planners Edible Arrangements Express Employment Professionals Eye Level Learning Centers FastSigns GNC Goddard Systems Great Clips Heavens Best Carpet and Upholstery Cleaning Home Instead Senior Care HR Block JanPro Jiffy Lube Kumon Math and Reading Centers Liberty Tax Service Maaco Mac Tools Massage Envy Matco Tools Meineke Merry Maids Midas Minuteman Press Molly Maid Pearle Vision Platos Closet Pop A Lock ReMax LLC RentACenter RooterMan ServiceMaster Clean Servpro Signarama SnapOn Tools Sport Clips Supercuts UPS Store Valvoline Vanguard Cleaning Systems Weed Man Other
What is the name of your franchise?
How Many Units Do You Own?
Do You Own A 2nd Franchise? Yes No
Name Of Franchise
Do You Own A 3rd Franchise? Yes No
Comments
By submitting this form: 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. By submitting, you are digitally dating and signing this form.