Mr. Pickle's Sandwich Shop - Franchise Application

Mr. Pickle's Francise Systems, LLC (MPFS) requires this form to be completed by: (1) each business partner, or (2) each stockholder owning 20% or more of voting stock, or (3) any person or entity providing a guaranty on the loan. MPFS may at it's discretion request additional and/or more detailed information.

We may require proof on items listed on the financial statements including cash on hand, bank statements, IRAs, Stocks & Bonds, Real Estate, and / or loan approvals.

This information is not intended as an offer to sell, or the solicitation of an offer to buy, a franchise. It is for informational purpose only. Currently the following states regulate the offer and sale of Franchises: California, Hawaii, Illinois, Indiana, Maryland, Michigan, Minnesota, New York, North Dakota, Oregon, Rhode Island, South Dakota, Virginia, Washington, and Wisconsin. If you are a resident of one if these states, we will not offer you a franchise until we have complied with applicable pre-sale and disclosure requirements in your state of residence.

Thank you,

Mr. Pickle’s Franchise Systems, LLC.
Name:*

First NameMiddle NameLast Name
Email*
example@example.com
Mobile Phone Number*

Area CodePhone Number
Current Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Number of years at your current address:*
Education
Highest level completed:*
Additional Information, type of degrees earned, & other skills or training
Employment
Business or Employment (10 years)
Company Name *
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Title*
Dates of Employment*
Ex: From 1/1/2005 to Present
Previous Employer
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Title
Dates of Employment
Ex: From 1/1/2001 to 1/2/2005
Business Partners
Mr. Pickle’s Franchise Solutions, LLC., requires all business partners to complete an application.
Please list any additional business partners:

Other Background Information
During the past 10 years, have you and / or any applicable spouse, partners, officers, directors,shareholders or other principals of your business ever:
Been the subject of, or a party to any litigation, liens, judgments, or administrative sanction?*
If yes, please explain:
Been convicted, entered a plea of no contest, had prosecution deferred, or adjudication withheld for any crime other than a minor traffic violation?*
If yes, please explain:
Been adjudicated bankrupt or reorganized due to insolvency?*
If yes, please explain:
Are you a cosigner or guarantor of any other debt?*
If yes, please explain:

Your Plans for a Mr. Pickle's Sandwich Shop
Location Preference #1*
Type City, State and/or County
Location Preference #2
Type City, State and/or County

Number of shops you would like to develop the next 5 years*

	Year 1	Year 2	Year 3	Year 4	Year 5
Number

Do you plan to devote your full time to this venture?*
If not, please explain:
Financing

How will you finance this franchise investment? What are the total funds available?*

	Cash	IRA	SBA	Business Loan
Amount Available

Do you plan to obtain a loan for this franchise?*
Do you currently own/operate any other franchise or business?*
If yes, please list
Will any family members be active in the franchise?*
If yes, please explain

Personal Financial Statement

If you have a current Personal Financial Statement, you may upload it by clicking browse files below.

You may need to submit proof of funds, loan approval letters and statements matching what you claim.
I will submit my own Personal Financial Statement. You may skip to Section 9 if you are uploading your own Personal Financial Statement.*

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Upload Files
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ASSETS - if item doesn't apply enter 0 (zero)

	Entry should be in whole dollars
Cash on hand & in Banks
Savings Accounts
IRA or Other Retirement Account
Accounts & Notes Receivable
Life Insurance-Cash Surrender Value only (Complete Section 8)
Stocks & Bonds (Describe in Section 3)
Real Estate (Describe in Section 4)
Automobile-Present Value
Other Personal Property (Describe in Section 5)
Other Assets (Describe in Section 5)

Total Assets - This field will auto calculate.

LIABILITIES - If item doesn't apply enter 0 (zero)

	Entry should be in whole dollars
Accounts Payable
Notes Payable to Banks and Others (Describe in Section 2)
Installment Account (Auto)
Installment Account (Other)
Loan on Life Insurance
Mortgages on Real Estate (Describe in Section 4)
Unpaid Taxes (Describe in Section 6)
Other Liabilities (Describe in Section 7)
Contingent Liabilities as Endorser or Co-Maker
Legal Claims & Judgments
Provision for Federal Income Tax
Other Special Debt

Total Liabilities - This field will auto calculate.
Net Worth - (Assets minus Liabilities) - This field will auto calculate.

Section 1: Source of Income

Source of Income: If item doesn't apply enter 0 (zero)

	Entry should be in whole dollars
Salary
Net Investment Income
Real Estate Income
Other Income (Describe Below)*

Description of Other Income
*Alimony or child support payments need not be disclosed in Other Income unless it is desired to have such payments counted toward total income.
Total Income Calculated - This field will auto calculate.
Section 2: Noteholder(s)

Notes Payable to Banks, Finance Companies, Credit Cards and others.

	Name	Address	Original Balance	Current Balance	Payment Amount	Frequency (Monthly, etc.)	How Secured or Endorsed
Noteholder #1
Noteholder #2
Noteholder #3
Noteholder #4
Noteholder #5
Noteholder #6
Noteholder #7
Noteholder #8

Section 3: Stocks & Bonds

	Number of Shares	Name of Securities	Cost	Market Value Quotation/Exchange	Date of Quotation/Exchange	Total Value
#1
#2
#3
#4
#5

Section 4: Real Estate Owned

	Property A	Property B	Property C
Type of Property
Address
Date Purchased
Original Cost
Present Market Value
Name & Address of Mortgage Holder
Mortgage Acct.#
Mortgage Balance
Amount of Payment Per Month
Status of Mortgage

Section 5: Other Personal Property & Other Assets
Describe any other personal property and assets. State name and address of lien holder, amount of lien terms of payment, and if delinquent- describe delinquency.
Section 6: Unpaid Taxes
Describe in detail as to type, payable to, when due, amount, and to what property-if any-that a tax lien exists on.
Section 7: Other Liabilities
Describe in detail:
Section 8: Life Insurance Held
Give face amount and cash surrender value of policies - name of insurance company & beneficiaries.

Section 9: Release and Authorization
I authorize Mr. Pickle’s Franchise Systems, LLC. (MPFS) to make inquiries as necessary to verify the accuracy of the statements made, and to determine my credit worthiness. I certify the above and the statements contained in the attachments are true and accurate as of the stated date(s). These statements are made for the purpose of either obtaining a loan, or guaranteeing a loan and/or determining the credit worthiness to open a Mr. Pickle's Sandwich Shop franchise unit. I understand MPFS is relying upon this information in considering my application. MPFS may terminate the franchise or loan application if there are any misrepresentations or material omissions on this application.
I agree, if any of the information outlined in this application changes, applicant is responsible to inform MPFS of the changes immediately. I understand that this application, once submitted to MPFS, is valid for 90 days. If an application is not accepted within 90 days an updated application package must be submitted.
Individual Application
Release and Authorization

All information contained in this Franchisee Application is confidential and is strictly for the purpose of facilitating the Mr. Pickle's Sandwich Shop franchise application process. All applicants will receive consideration without regard to race, color, age, religion, gender, disability, or national origin.

I acknowledge that the submission of this application does not obligate either me or Mr. Pickle’s Franchise Systems, LLC. (MPFS), in any manner, nor does it imply that there is any legal or commercial relationship between either party. I acknowledge that MPFS reserves the sole right to approve or disapprove this application for any reason it may determine, and in the event that MPFS disapproves this application, it shall have no liability to the undersigned.

I certify that the information supplied by me is true and correct. I hereby voluntarily and knowingly, authorize any present or past employer or supervisor, business associates, law enforcement agency, credit bureau, creditors, collection agency, banking institution, private business, military branch, and any other persons to release any information they may have concerning me to MPFS, and/or its authorized agents. I voluntarily and knowingly and unconditionally release any of the above-named agencies and persons from any and all liability resulting from furnishing this information.

I expressly agree to notify MPFS immediately in writing of any material change in my financial condition.

I acknowledge that the Fair Credit Reporting Act entitles me to know if credit is denied because of information contained in any report issued by a Consumer Reporting Agency. In the event that this takes place, I will be notified by MPFS, and provided the name of the Consumer Reporting Agency. I agree that this release shall be valid in photocopied form.

The undersigned authorizes MPFS to obtain business reports, perform credit, background, and criminal checks on the applicant's legal entity and/or individuals.
Signature*

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Please Type your Name*
Individual Application
Confidentiality and Proprietary Information Agreement

I hereby acknowledge that all the information related to methods of operating a Mr. Pickle's Sandwich Shop, building plans, equipment, supplies, suppliers, costs, recipes, system standards, training manuals, videos, profit information, and any other information relating to the business interest of Mr. Pickle's Franchise Systems, LLC (MPFS) revealed to me in connection with my application to become a franchisee, is a trade secret, confidential, and proprietary information wholly owned by MPFS. I agree that such information is received by me in confidence, and agree that I shall not disclose any part of it to others, or use any part for my own benefit or for the benefit of any third party, without the written consent of MPFS.

I further agree that all written materials, drawings, instruments, or documents of any type which I may receive from MPFS, shall remain the property of MPFS, and that these items are loaned to me by MPFS, for limited purposes. I agree that these documents shall not be reproduced in whole or in part, and I agree to return these documents upon completion of the use for which they are loaned or otherwise, immediately upon request.

I also agree that I shall not, in any event, contest or deny the validity of the trademark, trade name, or trade dress rights in the marks of MPFS, or marks similar thereto, and I shall not use any such marks except as authorized under the Franchise Agreement.
Applicant Signature*

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Full Legal Name
Please Type your Full Legal Name*
Date

MonthDayYear
Date
Once submitted , you will get a confirmation email with your submission.

Should be Empty:

Education

Employment

Business or Employment (10 years)

Previous Employer

Business Partners

Other Background Information

Your Plans for a Mr. Pickle's Sandwich Shop

Financing

Personal Financial Statement

Section 1: Source of Income

Section 2: Noteholder(s)

Section 3: Stocks & Bonds

Section 4: Real Estate Owned

Section 5: Other Personal Property & Other Assets

Section 6: Unpaid Taxes

Section 7: Other Liabilities

Section 8: Life Insurance Held

Section 9: Release and Authorization