Paisanos Franchise Application Form

Thank you for your interest in the Paisano’s Franchise System. The following will outline the process and steps that are required to be considered for a Paisano’s Franchise:

Complete this Franchise Application and return it to us by mail to Capital Restaurant Group at 4465 Brookfield Corporate Dr. Suite 202 Chantilly, VA 20151, attention: Gary Wise; or e-mail to [email protected].

A separate Franchise Application should be completed by each applicant.

Upon receipt, we will review and evaluate your application and, if approved, provide you a Franchise Disclosure Document (“FDD”).

We may provide you with a FDD in hard copy or electronic format. If the FDD is furnished electronically, it will be provided in a Portable Document Format (PDF) file. You must use the Adobe Acrobat program in order to open and view this type of electronic file.

Upon receipt of the FDD, please complete and sign the final two pages of the document entitled “Receipt.” Once completed and signed, return the Receipt entitled “Our Copy” to the address indicated above.

It is recommended that you review the Pisano’s FDD with your attorney and business advisors.

Under no circumstances does the submittal of your application to Paisano’s or its subsequent review and processing imply, in any manner, our intention to offer you a Franchise. You are not accepted as a Paisano’s Franchisee unless and until you and Paisano’s execute a Franchise Agreement.

Paisano’s does not guarantee the financial performance of any Franchisee or business. The decision to become a Paisano’s Franchisee and to open a Paisano’s Franchise must be based upon your independent research and analysis.

Personal Information

Paisanos Franchise - Personal Information

Name:(Required)

First Last

Date of Birth(Required)

MM/DD/YYY

Social Security Number:(Required)

Driver License Number:(Required)

Drivers License State:(Required)

Spouse Name:(Required)

First Last

Date of Birth(Required)

MM/DD/YYYY

Social Security Number:(Required)

Drivers License State:(Required)

Driver License Number:(Required)

Home Phone Number:(Required)

Cell Phone Number:(Required)

Work Phone Number:(Required)

Fax Number:(Required)

Email(Required)

Children Including Age:

Highest Education Completed:(Required)

High School(Required)

College(Required)

Master's(Required)

Other(Required)

Home Adress: Own or Rent (Select One)(Required)

Own

Rent

Home Address(Required)

City:(Required)

State(Required)

Zip Code:(Required)

Monthly Rent or Mortgage Payment:(Required)

How Long at This Address:(Required)

If less than 2 Year

2 to 5 Years

More than 5 Years

If Less Than 2 Years, Provide Your Previous Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employment Information

Employer:(Required)

Type of Business:(Required)

Employer Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Position:(Required)

Supervisor:(Required)

Current of Final Salary:(Required)

Reason for Leaving:(Required)

May We Contact Employer:(Required)

Yes

Credit References (Companies with whom you have done business)

Name:(Required)

First Last

Contact Person:(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number:(Required)

Account Type:(Required)

Name:(Required)

First Last

Contact Person:(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number:(Required)

Account Type:(Required)

Name:(Required)

First Last

Contact Person:(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number:(Required)

Account Type:(Required)

Personal References

Name(Required)

First Last

Phone Number:(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Relation To You:(Required)

Name:(Required)

First Last

Phone(Required)

Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Relation To You:(Required)

Name:(Required)

First Last

Phone(Required)

Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Relation To You:(Required)

General Information

How did you learn of the Paisano's? Franchise opportunity?(Required)

What made you approach Paisano's about becoming a Franchisee?(Required)

In what City and State are you interested in operating a Paisano's Franchise?(Required)

Number/Type of Franchises you are considering (Select One):

How much cash are you prepared to invest in a Paisano's Franchise?(Required)

What experience do you have which would prepare you to operate a Paisano's Franchise"(Required)

Will you devote your full time and attention to operating your Paisano's Franchise?(Required)

If you answered no, who will be responsible for operating your business?(Required)

What is your time frame for the opening of your Paisano's Franchise?(Required)

Do you have a particular site you are presently interested in?(Required)

If so, please provide details.(Required)

Have you ever been involved with a franchised business?(Required)

If so, please provide details.(Required)

Financial Information

As of this Date:(Required)

Monthly Income:

Salary, Wages:(Required)

Bonus, Commissions:(Required)

Dividends, Interest:(Required)

Real Estate Income:(Required)

Notes/Accounts Receivable:(Required)

Other Income (specify source):(Required)

Total Monthly Income:(Required)

Assets - Liabilities (Amounts)

Cash(Required)

Note Payable to Banks(Required)

Stocks and Bonds(Required)

Notes Payable to Othes(Required)

IRA's(Required)

Loans Against Life Insurance(Required)

401 K's(Required)

Credit Cards(Required)

Life Insureance (Cash Surrender Value)(Required)

Mortgage (Home)(Required)

Real Estate (Home)(Required)

Mortgage (Home)(Required)

Real Estate (Other)(Required)

Due on Vehicles(Required)

Vehicles(Required)

Accounts Payable(Required)

Accounts/Loans Receivable(Required)

Taxes Payable(Required)

Other Assets:(Required)

Other Liabilities:(Required)

TOTAL ASSETS(Required)

TOTAL LIABILITIES(Required)

NET WORTH (Assets less Liabilities)(Required)

Applicant Approval

Acknowledgments and Signature

I hereby certify that the above information contained in this Franchise Application is true and correct. I understand that the above information will be utilized by Paisano's in its evaluation of my expression of interest in acquiring a Paisano's Franchise. I understand that in submitting this application I am not agreeing to be obligated to acquire a Paisano's Franchise and that acceptance of my application is not an agreement to grant me a franchise opportunity, which will only occur upon execution of a Franchise Agreement. I further understand that if Paisano's decides to proceed with my application, I will be provided, prior to execution of any binding agreement, with a Franchise Disclosure Document.

In accordance with the Privacy Act (5 U.S.C. 552 a), Freedom of Information Act, and the Fair Credit Reporting Act, I expressly authorize any past or present employer, any law enforcement agency (federal, state, or local), or any person who has personal knowledge of my character, work experience, or criminal records to release information to Paisano's. I understand and acknowledge that as a condition of being considered for a Paisano's Franchise, I agree to a credit history check and a criminal background check to be performed by a reputable agency at the choice of Paisano's. I understand that the credit and criminal reporting agencies will make their results known to Paisano's and Paisano's may use those results, in whole or in part, in determining whether I will be granted the right to enter into a Franchise Agreement with Paisano's. If requested by Paisano's, I agree to supply statements from my professional advisors (banker, broker, accountant, or attorney) verifying the assets stated on the application, and I also agree, if requested, to furnish copies of Federal Income Tax Returns (along with any supporting Schedules) as filed for the last three years. I understand that Paisano's is relying upon all of the information contained in this application as a material factor in considering my application to become a Paisano's Franchisee, and I, therefore, agree to promptly notify Paisano's of any material change in any of this information or any subsequent information provided to Paisano's. In addition, I release from liability and hold harmless all persons releasing personal, professional, or financial information on me or any company to which I am a partner or shareholder listed on this application.

I further agree to provide a detailed resume and a current personal financial statement upon the request of Paisano's.

Applicant Name(Required)

First Last

Date Form Signed(Required)

Consent(Required)

By checking the following consent I agree

Signature(Required)

Untitled

Paisanos Franchise Application Form

Personal Information

Paisanos Franchise - Personal Information

Employment Information

Credit References (Companies with whom you have done business)

Personal References

General Information

Financial Information

Monthly Income:

Assets - Liabilities (Amounts)

Applicant Approval

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