Take the next step | Franchise Pre-Application

First Name*

Middle Initial

Last Name*

Street Address*

P.O. Boxes will not be accepted

City*

State*

Zip Code*

Country*

Daytime Phone*

Evening Phone

Cellular Phone

Fax

Email*

Birthplace*

Birthdate*

Are you a US Citizen*

Yes

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

College

Names and locations of high school and colleges you attended:

Any other education, including correspondence courses and their completion dates:

Social and Community Life

Tell us about any interests/participation you have in your community

What do you enjoy doing in your spare time?

Business History

Are you currently:*

Self Employed

Employed

Unemployed

Retired

Current Employer

Dates:

From

Company

Phone

Street Address

City

State

Zip Code

Country

Job Title

Current Annual Compensation

Name of Supervisor

May we contact them?

Tell us about your responsibilities

Previous Employer

Dates:

From

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 responsibilites

Reason for Leaving

About You

Do you now or have you ever owned your own business?*

Yes

If yes, please briefly describe

Do you have any restaurants or food service experience?*

Yes

If yes, please list restaurant names and locations

Do you have any other current business interests or holdings?*

Yes

If yes, please explain

Have you ever filed for bankruptcy protection?*

Yes

If yes, please explain in detail

Have 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

If yes, please outline the circumstances, dates, and current disposition

Please attach your current resume

Max. file size: 500 MB.

You and Steak Escape

How 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

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

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

If yes, where?

Would you be operating your Steak Escape business yourself?*

Yes

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 each

Finances 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 loan

Assets

When entering amounts, omit cents

Cash on hand & in banks

Savings Accounts

IRA or Other Retirement accounts

Accounts and Notes Receivable

Life Insurance-Cash Surrender Value only

Stocks and Bonds

Real Estate

Automobile – Present Value

Other Personal Property

Other Assets

Total

Liabilities

When entering amounts, omit cents

Accounts Payable

Notes payable to Banks and Others (Describe in Section 2)

Installment Account (Auto)

Mo. Payments

Installment Account (Other)

Mo. Payments

Loan on Life Insurance

Mortgages on Real Estate

Unpaid Taxes

Other Liabilities

Total Liabilities

Net Worth

Total

Section 1.

Source of Income

Salary

Net Investment Income

Real Estate Income

Other Income

Describe Below

Description 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 Liabilities

As Endorser or Co-Maker

Legal Claims & Judgements

Provision for Federal Income Tax

Other Special Debt

Section 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 Noteholder

Original Balance

Current Balance

Frequency (monthly, etc.)

Payment Amount