Request for Consideration Request for Consideration Ori’Zaba’s Request For Consideration I would like to take the next step by completing this form in full and receiving additional information. I understand this in no way obligates either party in any manner. The information provided will remain secure and confidential. Contact Information First Name * Last Name * Phone Number Preferred Call Times * Email Address * Address * Address Street 1 Street 1 Street 2 Street 2 City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Date Of Birth * Are you currently Married? * Yes No Spouse Full Name * Spouse Occupation * Employment, Education, Experience Employer Name * Current Employer name. If self-employed, list company name Employer Address Employer Address Employer Address Employer Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Number of Dependents * 0123456789101112 Age of Dependent * 12345678910111213141516171819202122232425 plus1 Add minus1 Remove Have you Been Convicted Of a Crime? * Yes No Please Explain * Have You or Your Spouse Ever Declared Bankruptcy? * Yes No Please Explain Declared Bankruptcy * College Post Graduate Education? * Yes No Name of Institution * Years Completed * 123456789 plus1 Add minus1 Remove Do you have Sales/Management Experience? * Yes No Please Elaborate Sales/Management Experience? * Describe Business Experiences That Will Enable You To Coach, Train, & Supervise Staff. * Have You Ever Owned or Been Involved With A Franchised, Food Related, Or Start Up Business? * Yes No Please Name & Describe * Employment History. Attach Resume or Bio. * Drop a file here or click to upload Choose File Maximum file size: 78.64MB Franchise How Did You Learn About Ori’Zabas * Have You Visited One Of Our Restaurants? * Yes No Are You Interested In Single Site, Multiple Sites, Or Unsure At This Time? * Single Site Multiple Sites Unsure at this time If Approved, Where Is Your Ideal Restaurant Location? Will It Require You To Relocate? * How Many Hours Per Week Will You (and/or Spouse/Business partner) Dedicate to the Franchise? * Please Explain Why You’re an Ideal Franchise Candidate. * If Approved, When Would You Like To Start ? * Financials Do You Understand: Your investment in an Ori’Zaba’s Mexican Grill may vary greatly depending on a variety of factors. Information regarding types of costs you should expect and the recent range for these costs can be found in our Franchise Disclosure Document and on the Franchising page of zabas.com. We require potential franchisees to have minimum liquid funds of $200,000 and net worth of a $400,000. * YesNo Will You Be Securing A Loan To Pay For Part Of Your Investment In Your Franchise? Have You Obtained Pre-Approval? Please Elaborate. * How Much Cash (outside of loans) Will You Invest, And What are the Sources? Describe Sale Of Assets, Partners, Famliy Funds, Etc. * Previous 12 Month Salary, Wages, Bonuses, Commissions * $ Enter 12 Month Total Previous 12 Month Dividends, Interest $ Previous 12 Month Other Income $ Please Describe Other Income * Total Income $ Attach Banking and Other Income Statement for 12 Month Period Attach Banking and Other Income Statement for 12 Month Period Drop a file here or click to upload Choose File Maximum file size: 78.64MB plus1 Add minus1 Remove Asset Information Checking and Savings Provide last 4 digits of the account * Enter dollar amount currently in Checking/Savings * $ plus1 Add minus1 Remove Total Checking and Savings $ Stocks, Bonds, Brokerage Accounts Provide last four digits of the account Amount currently in stocks, bonds, and accounts $ plus1 Add minus1 Remove Total Stocks, Bonds, Brokerage Accounts $ Retirement Accounts Last four digits of IRA, 401K or other accounts * Enter dollar amount of Retirement account * $ plus1 Add minus1 Remove Total Retirement Accounts $ Real Estate Describe Real Estate Property Type * Enter Estimated Property Value * $ plus1 Add minus1 Remove Total Real Estate Accounts $ Auto/Personal Property Describe Auto/Personal Property * Enter Auto/Personal Property Value * $ plus1 Add minus1 Remove Total Auto/Personal Property $ Other Assets Describe any other assets not reflected above Other Assets Amount * $ Total Assets $ Debt Information Credit Card Credit Card Debt * Please provide last 4 digits of Credit Card Credit Card Debt Balance * $ Please enter current balance of Card plus1 Add minus1 Remove Total Credit Card Debt $ Loans/Mortgages Loans/Mortgages Account * Please enter the last 4 digits of Loan/Mortgage #1 account number Loans/Mortgages Balance * $ Please enter current balance on Loan/Mortgage plus1 Add minus1 Remove Total Loan/Mortgages Debt $ Other Debts. Please Elaborate. Please describe other debts not reflected above Other Debt Balance * $ Summary Financials Total Debt $ Total Net Worth $ Additional Documents Other Documents You Wish To Attach (such as business plans, bank recommendations, etc.) Select Add to upload more than one document. Additional Documents Document Purpose Upload Document Drop a file here or click to upload Choose File Maximum file size: 78.64MB plus1 Add minus1 Remove Authorization All the above information is correct and Ori’Zaba’s Franchise Operations, LLC, has my permission to verify. * Yes Signature * Clear If you are human, leave this field blank. Submit 0/5 (0 Reviews)