Franchise Application - Mr. Gatti's Pizza

Name*

First Middle Last

Phone*

Email*

Address*

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

Are you a US Citizen?*

Yes
No

Do you have access to the funds needed to open a Gatti's Pizza franchise?*

Yes
No

Are you a defendant in any lawsuits or legal action?*

Yes
No

Are you a veteran?*

Yes
No

Have you ever filed bankruptcy or are you in process of filing bankruptcy?*

Yes
No

Have you ever been convicted of a felony or misdemeanor (other than traffic violations)?*

Yes
No

How did you hear about this Opportunity?*

Magazine
Store Visit
Referral
Trade Show
Internet
Other

Which Magazine?*

Which Location?*

By Whom?*

Specify*

Describe*

Date of Birth*

Social Security #*

Savings Account Balance*

Home Value*

Value of Stocks, Bonds, 401k or Investments*

Value of Other Assets, Property or Investments*

Total Value of Assets*

Current Salary / or Fees*

Dividends, Interest or Real Estate Income*

Other Income*

Total Income*

Balance Due on Auto Loans*

Balance Due on Mortgage*

Balance Due on Other Loans or Debts*

Total Liabilities*

Your Estimated Net Worth (Total Assets plus Income minus total liabilities)*

Do You Have a Spouse or Partner That Will Be Actively Involved in the Franchise?*

Yes
No

What is Your Spouse or Partner's Name?

What Method of Financing Are You Considering?

Will you be working in the store yourself on a day-to-day basis?*

Yes
No

If not, please provide the name and contact for your General Manager.*

Do you have experience developing and/or operating casual/full service restaurants?

Yes
No

Do You Plan on Financing Any Portion of Your Franchise?*

Yes
No

Please describe any other business or management experience you have that would be useful in operating a franchise.

Any additional comments / information you would like us to consider?

Rate Your Overall Computer Skills, 5 being the highest*

Rate Your Overall Networking and Sales Skills, 5 being the highest*

Rate Your Organizational Skills, 5 being the highest*

Signature*

I certify that I have the authority to complete this Application on behalf of the Applicant and that the information contained in this Application is true and accurate as of the date shown below. I acknowledge that Mr. Gatti's, LP is relying upon all the above information as a material factor in considering this Application, and I therefore agree to promptly notify Mr. Gatti's, LP of any material change in the information contained in this Application or any sub- sequent information provided to Mr. Gatti's, LP. I understand and acknowledge that, as a condition of this Application being considered, the Applicant must submit to a credit history check and a criminal background check to be performed by an agency of Mr. Gatti's, LP's choice. I understand that the credit and criminal reporting agencies will make their results known to Mr. Gatti's, LP, and Mr. Gatti's, LP may use those results in determining whether the Applicant will be granted the right to enter into a development and/or franchise agreement with Mr. Gatti's, LP. If requested by Mr. Gatti's, LP, I agree to supply statements from the Applicant's professional advisors (banker, broker, accountant or attorney) verifying its assets, and furnish copies of its income tax returns as filed for the last three years. 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 Mr. Gatti's, LP.

I understand that Mr. Gatti's, LP may approve or deny this Application in its sole discretion and for any reasons or for no reason whatsoever and that approval of this Application may be revoked at Mr. Gatti's, LP's sole discretion if any information contained herein is later deemed to be false or misleading. I agree, on behalf of the Applicant, to indemnify Mr. Gatti's, LP, its affiliates and successors and their respective directors, officers, agents, and employees, past or present, from all losses and expenses arising from the breach of any representation in this Application, including any actual or threatened action and independent defense thereof. Further, on behalf of the Applicant, I hereby release Mr. Gatti's, LP, its affiliates and successors and their respective directors, officers, agents, and employees, past or present, from any liabilities, losses or expenses related to its approval, disapproval or revocation of approval of this Application. I hereby certify that all above information is true and complete to the best of my knowledge.

Signature*

I submit the information contained herein as my complete and true personal and financial condition as of the date shown above. In accordance with the Privacy Act (5 US.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 this information to Mr. Gatti’s, LP. I understand and acknowledge that, as a condition of being considered for a Mr. Gatti’s franchise, I must submit a credit history check to be performed by a credit reporting agency of Mr. Gatti’s choice.

I also agree to supply statements from my professional advisors (i.e., banker, broker, accountant, or attorney) verifying the above assets, and if requested, I also agree to furnish copies of Federal Income Tax Returns as filed for the last three years. I understand that Mr. Gatti’s is relying upon all the above information as a material factor in considering my application and interest to become a Mr. Gatti’s franchisee, and I therefore agree to promptly notify Mr. Gatti’s of any material change in any of the above information or any subsequent information provided to Mr. Gatti’s. In addition, I release all persons from liability as a result of disclosure of the above-described information.

DISCLOSURE REGARDING BACKGROUND INVESTIGATION*

Gatti’s Pizza ("the Company") may obtain information about you for franchising purposes from the following consumer reporting agency ("Agency"), Accurate Public Records, P.O. Box 72185, Albany, GA 31708, Phone: (229) 869-5831, Fax: (229) 869-5831, or another outside organization. Agency's privacy policy can be found at Accuratepublicrecords.com.

Thus, you may be the subject of a "consumer report" and/or an "investigative consumer report" which may include information about your character, general reputation, personal characteristics, and/or mode of living, and which can involve personal interviews with sources such as your neighbors, friends, or associates. These reports may be obtained at any time after receipt of your authorization and, if you are accepted, throughout your time as a franchisee. These reports may include, but are not limited to, checks regarding your criminal history, social security trace, employment and education references, driving history, professional licenses and credentials. Credit history will be requested only in accordance with applicable law. These reports may contain information regarding your use of social media, and other publicly accessible information. Social media includes, but is not limited to, social networking websites (i.e., Facebook and others), professional networking websites (i.e., LinkedIn and others), blogs, and other online media.

You have the right, upon written request made within a reasonable time after receipt of this notice, to ask the Company to disclose the nature and scope of any investigative consumer report. You also may request a copy of that report from the Company. If anyone other than Agency furnishes an investigative consumer report, Company will provide relevant contact information within five business days of your request. An "investigative consumer report" is a background report that includes information from personal interviews (except in California, where that term includes background reports with or without personal interviews). Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for franchising is an investigation into your education and/or employment history conducted by Agency. The scope of this disclosure and authorization is all encompassing, however, allowing Company to obtain from any outside organization all manner of consumer reports and investigative consumer reports now and, if you are accepted, throughout your time as a franchisee to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report.

Maine, Massachusetts, and New Jersey applicants only: You have the right to inspect and promptly receive a copy of any investigative consumer report requested by Company by contacting the consumer reporting agency identified above directly.

Minnesota applicants only: You have the right, upon written request to Agency, to receive a complete and accurate disclosure of the nature and scope of any consumer report. Agency must make this disclosure within five days of receipt of your request or of the Company's request for the report, whichever is later.

New York applicants only: You have the right to request whether Company requested a consumer report and, if so, Company will give you the name and address of the report's provider if other than Agency.

California, Minnesota and Oklahoma applicants only: Please contact Agency if you would like to receive from Agency a copy of any report furnished by Agency to the Company pursuant to your authorization below.

Washington applicants only: The Company will provide the disclosure described above concerning its procurement of an investigative consumer report either five days after receiving your request or after requesting the investigative consumer report, whichever is later. You have the right to ask Company to provide you with a summary of your rights under the Washington Fair Credit Reporting Act.

I acknowledge receipt of this Disclosure and certify that I have read and understand this document.