Request for Consideration

Request for Consideration

The Purpose of this Request for Consideration is for general information in evaluating your initial qualifications to be awarded an East of Chicago Pizza Company℠ franchise license. This form, when completed, is an essential part of our selection process. Please complete this form personally; typing your responses and giving specific answers to all questions. All answers are held in confidence. This form is not to be construed as an offer of an East of Chicago Pizza Company℠ franchise, a commitment or a binding agreement on either party. This form is to be completed by each proposed partner if a partnership or group.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Residential Phone Number*
Residential Fax Number
Work Phone Number*
Work Fax Number
Best Time to Call*

Schedule #1 - Banking References (List all bank accounts including Savings and Loans)

	Institution Name and Address	Contact Officer	Cash Balance
1.
2.
3.
4.
Total Schedule #1

Schedule #2 - Stocks & Bonds

Schedule #3 - Accounts/Notes Receivable

Schedule #4 - Real Estate Investments (list all real estate held)

Assets

	Amount
Cash on hand and in banks (Total of Schedule #1)
Stocks and bonds (Total of Schedule #2)
Accounts Receivable (Total of Schedule #3)
Real Estate Investments (Total of Schedule #4)
Net Value of Business
Life Insurance (Cash Value)
Other Assets
Total Assets (Total from all assets above)

Schedule #5 - Loans, Notes and Mortgage Payable

Schedule #6 - Credit Card Debt

Liabilities

	Amount
Loans, Notes, and Mortgage Payable (Total of Schedule #5)
Accounts and Bills Due (Monthly Utilities, etc.)
Taxes Due
Credit Card Debt (Total of Schedule #6)
Other Liabilities
Total Liabilities (Total from all liabilities above)

Discuss two present and two previous BUSINESS goals and levels of achievement with those goals.
Discuss two present and two previous PERSONAL goals and levels of achievement with those goals.
Please summarize your interest in franchising, specifically with East of Chicago Pizza Company.
Any additional information may be added here.
The undersigned hereby certifies that the information on this Request for Consideration form is true and complete. The undersigned authorizes East of Chicago Pizza Company℠ to conduct an in-depth investigation as to the undersigned's background, including but not limited to, educational background, employment history, credit history, personal character and other information which East of Chicago Pizza Company℠ may deem pertinent. The undersigned further authorizes any persons, company, employer, financial or educational institution to provide any information regarding the undersigned to East of Chicago Pizza Company℠.
Print Name*

First NameLast Name
Date*

MonthDayYear
Date
Signature*

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Education Experience