TO FILL OUT THE PERSONAL FINANCIAL STATEMENT, DOWNLOAD THE EXCEL FILE, FILL IT IN, AND RETURN WITH YOUR APPLICATION VIA THE FILE UPLOADER LOCATED IN THE FORM BELOW. Name Last Name Street Address Address Line 2 City State/Province/Region ZIP code Email (required) Home Phone Mobile Phone Work Phone Estate Own Your OwnRent a Restaurant Best Time of Day to Call Any timeMorningNoonEvening Best Day to Call Any dayMondayTuesdayWednesdayThursdayFridaySaturdaySunday Birthday Martial Status MarriedSingleWidowed If married, will spouse be active in the business? YesNoMaybe? Number of dependents Current Occupation Health Status ExcellentGoodFairPhysical LimitationsOther If Other Educational Background High School / Diploma / Years College / Degree(s) / Years Grad School / Degree(s) / Years / Licenses & Certifications Have you ever been self employed? What, if any, franchise involvement have you had? Activities What are your special interests and/or hobbies? List membership and level of involvement in any civic, service or professional organizations. General Information & Goals How long have you considered owning your own business and why? What type of business seems to appeal to you most? How did you first learn about Sam & Louie's? Why are you interested in owning & operating a Sam & Louie's franchise? What are your career & financial goals for yourself & your family? Will you have a business partner in your franchise? Describe them who they are and their relationship to you if so. Will you be responsible for the day-to-day operations for the business? If not, who will be? How will you finance the business? List your top 3 location preferences and why you think they will be successful for operating a Sam & Louie's franchise. When would you like to open? I agree to the the terms stated below I/We do hereby represent that all of the above information answers are true and complete to the best of my/our knowledge and belief. I/We recognize that Sam & Louie’s is not in any way obligated to offer a franchise to me/us because of my/our execution of this document. I/We acknowledge that any false statement in this application shall constitute sufficient cause to deny further consideration. I/We understand that an inquiry regarding my/our character, general reputation, personal characteristics and financial background may be made as a result of this application and hereby authorize the release of this information to Sam & Louie’s. A photographic copy of this authorization shall be as valid as the original.