Franchise Application 2023 "*" indicates required fields First Name* Middle Initial Last Name* Street Address* P.O. Boxes will not be acceptedCity* State* Zip Code* Country* Daytime Phone*Evening PhoneCellular PhoneFaxEmail* Birthplace* Birthdate* Are you a US Citizen* Yes No Marital Status* Single Married Divorced Widowed Spouse's Name Spouse's Birthplace Spouse's Birthdate Formal Education Please select the highest grade you’ve completed:High School 1 2 3 4 College 1 2 3 4 Names and locations of high school and colleges you attended:Any other education, including correspondence courses and their completion dates:Social and Community LifeTell us about any interests/participation you have in your communityWhat do you enjoy doing in your spare time?Business HistoryAre you currently:* Self Employed Employed Unemployed Retired Current Employer Dates:From To Company PhoneStreet Address City State Zip Code Country Job Title Current Annual Compensation Name of Supervisor May we contact them? Tell us about your responsibilitiesPrevious Employer Dates:From To Company Phone Street Address City State Zip Code Country Job Title Final Annual Compensation Name of Supervisor May we contact them? Tell us about your responsibilitesReason for LeavingAbout YouDo you now or have you ever owned your own business?* Yes No If yes, please briefly describeDo you have any restaurants or food service experience?* Yes No If yes, please list restaurant names and locationsDo you have any other current business interests or holdings?* Yes No If yes, please explainHave you ever filed for bankruptcy protection?* Yes No If yes, please explain in detailHave you ever been convicted of a crime, other than a traffic violation, been found guilty in a court martial, been refused a bond, or been involved in any legal action?* Yes No If yes, please outline the circumstances, dates, and current dispositionPlease attach your current resumeMax. file size: 500 MB.You and Steak EscapeHow did you learn about Steak Escape?*Why do you want to be a Steak Escape Franchisee?*If your application is approved, when would you want to open your new Steak Escape?*Are you willing to spend up to three weeks attending training classes in Columbus, Ohio?* Yes No Are you willing to send up to three candidates to Columbus, Ohio for management training for up to three weeks prior to your store opening?* Yes No Where would you like your Steak Escape to be located? (Please list locations in order of preference)*If your location preferences are not available, would you consider other areas?* Yes No If yes, where?Would you be operating your Steak Escape business yourself?* Yes No If no, who would operate it for or with you? If you expect to have partners in your Steak Escape business, we require a separate application for eachFinances and Net Worth Complete this form for: (1) each proprietor, or (2) each limited partner who owns 20% or more interest and each general partner, or (3) each stockholder owning 20% or more of voting stock, or (4) any person or entity providing a guaranty on the loanAssets When entering amounts, omit centsCash on hand & in banksSavings AccountsIRA or Other Retirement accountsAccounts and Notes ReceivableLife Insurance-Cash Surrender Value onlyStocks and BondsReal EstateAutomobile – Present ValueOther Personal PropertyOther AssetsTotalLiabilities When entering amounts, omit centsAccounts PayableNotes payable to Banks and Others (Describe in Section 2)Installment Account (Auto)Mo. PaymentsInstallment Account (Other)Mo. PaymentsLoan on Life InsuranceMortgages on Real EstateUnpaid TaxesOther LiabilitiesTotal LiabilitiesNet WorthTotalSection 1.Source of IncomeSalaryNet Investment IncomeReal Estate IncomeOther IncomeDescribe BelowDescription of Other Income in Section 1.*Alimony or child support payments need not be disclosed in “Other Income” unless it is desired to have such payments counted toward total income.Contingent LiabilitiesAs Endorser or Co-MakerLegal Claims & JudgementsProvision for Federal Income TaxOther Special DebtSection 2.Notes Payable to Banks and Others Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.Name and Address of NoteholderOriginal Balance Current Balance Frequency (monthly, etc.) Payment Amount How Secured or Endorsed Type of Collateral Name and Address of NoteholderOriginal Balance Current Balance Frequency (monthly, etc.) Payment Amount How Secured or Endorsed Type of Collateral Name and Address of NoteholderOriginal Balance Current Balance Frequency (monthly, etc.) Payment Amount How Secured or Endorsed Type of Collateral Name and Address of NoteholderOriginal Balance Current Balance Frequency (monthly, etc.) Payment Amount How Secured or Endorsed Type of Collateral Name and Address of NoteholderOriginal Balance Current Balance Frequency (monthly, etc.) Payment Amount How Secured or Endorsed Type of Collateral References Please list the name, relationship and daytime phone numbers of three references and provide a letter from each.Name Relationship Phone Name Relationship Phone Name Relationship Phone Reference Letters Drop files here or Select files Max. file size: 500 MB. Your Authorization This application is the first step in our process. It is not a contract and does not constitute an agreement to grant a franchise nor allow the use of any proprietary marks, information or intellectual property. You agree to hold all information you have received from Escape Enterprises, Ltd. regarding the Steak Escape® Franchise or Systems as completely confidential. You further agree that should it be determined that you violated this confidentiality understanding, Escape Enterprises, Ltd., in its sole discretion, may seek remedies under Ohio state law. Your acceptance of these terms further authorizes Escape Enterprises, Ltd., its employees or authorized agents to request information from banks, credit unions, savings and loan institutions, investment bankers, securities brokers, insurance companies or other financial institutions to release all information regarding your accounts, including: deposits, withdrawals or other financial transactions. You further authorize the release to Escape Enterprises, Ltd., any information requested regarding your character, credit standing or past employment. This authorization shall be valid for information up to the date of submission of this application and for ninety daysSignature Type full name to signDate CAPTCHA