PROSPERING TOGETHER Chicken Kitchen® is ready to offer a very selective group of individuals and corporations the opportunity to expand our concept in other markets across the USA and internationally, thru Franchising, Partnerships and Joint Ventures. We are looking for strong hands-on or proven Operators to partner with. At Chicken Kitchen® we strongly believe that the future success of our concept is tied to the quality of the Operators that we will select. It is their hard work, leadership, passion, skills, dedication, financial resources and approach to business that will make Chicken Kitchen® a great success. That’s why we take great care and time in selecting our Partners/Operators. We are just looking for the right fit. Please let us know what market(s) you are interested in and if you are interested in the Franchise, Partnership or Joint Venture program? APPLY ONLINE: you can fill-out the Franchise Application below and submit it to us online. BY EMAIL: you can download the Franchise Application here. Print it, fill it out and send it to us by email at franchise@chickenkitchen.com BY FAX: you can download the Franchise Application here. Print it, fill it out and send it to us by fax at 305.892.7887 If you have any questions please contact Juanita Matallana, VP of Development & Franchising at 786.230.9311 or by email at franchise@chickenkitchen.com Personal Information: (personal and confidential) In order for Chicken Kitchen to commence processing your application for franchise approval, you must complete the following questionnaire in its entirety, and have each investor/partner fill out a separate franchise application. Your First & Last Name (required) Your Email (required) Your Phone Number (required) Street Address (required) City (required) State (required) Zip Code (required) Country (required) Social Security Number Do you own or rent your home? (required) OwnRent How long have you lived at your current residence? (required) If renting, name and phone number of landlord Former residence How long? Date of birth Height Weight Marital Status Number of children Number of dependents Spouse's name Spouse's Social Security Spouse's occupation Spouse's citizenship Languages spoken fluently Education level Degrees Major Your degree last earned Are you a citizen of the U.S.A? YesNo If no, which country? Immigrant status in the U.S.A? Alien number Memberships in professional or civic organizations Personal interests and hobbies Describe any physical disabilities or limitations Community involvement Are you, or a business entity owned or controlled by you currently involved in any lawsuits or any other legal actions, either as plaintiff or defendant? YesNo If yes, please state date and details Have you ever been convicted of a felony or misdemeanor (other than a minor traffic violation)? YesNo If yes, please state date and details Have you, or a business entity owned or controlled by you ever been involved in a bankruptcy? YesNo If yes, please state date and details Personal and Bank References: List three people who have known you at least 5 years (please do not include employees or relatives) Name Relationship Phone Years Known Name Relationship Phone Years Known Name Relationship Phone Years Known Business Experience: Present Position Type of Business Employer Name Superior Name Employer Phone Annual Income Spouse's Income Employer Address May we contact your present employer? YesNo If no, please state reason why Describe duties, responsibilities and number of employees supervised Employed from Employed to Previous Position Type of Business Employer Name Superior Name Employer Phone Employer Address May we contact your present employer? YesNo If no, please state reason why Describe duties, responsibilities and number of employees supervised Employed from Employed to Restaurant and Franchise Experience: Have you ever worked in a restaurant? YesNo If yes, please give details Name Location Have you ever owned or managed a restaurant? YesNo If yes, please give details Name Location Have you ever owned or managed a small business? YesNo If yes, please give details Name Location Have you ever owned or managed a franchise business? YesNo If yes, please give details Name Location How did you learn of Chicken Kitchen? What appeals to you the most about Chicken Kitchen? Are you evaluating other business opportunities? YesNo If yes, please give details Are you evaluating other restaurant opportunities? YesNo If yes, please give details Are you evaluating other restaurant franchises? YesNo If yes, please give details Are you evaluating other chicken franchises? YesNo If yes, please give details Do you own any other businesses? YesNo If yes, please give details Do you plan to devote full time to this business? YesNo If not, what amount of time weekly Do you plan to have partners/co-owners in this venture? YesNo How many? If yes, please give their names and have each partner complete a separate franchise application form Partner #1 Name Partner #1 Address Partner #1 Cash Contribution Partner #1 Ownership % Partner #2 Name Partner #2 Address Partner #2 Cash Contribution Partner #2 Ownership % Partner #3 Name Partner #3 Address Partner #3 Cash Contribution Partner #3 Ownership % Partner #4 Name Partner #4 Address Partner #4 Cash Contribution Partner #4 Ownership % Who will be the operating partner? What percentage of the business will they own? What percentage of the equity of the restaurant business will you own? How will you finance this investment? Personal Funds: Borrowed Funds: What would be your source of borrowed funds? Cash: Partners: Loan: Collateral: Will the Chicken Kitchen franchise be considered your primary source of income? YesNo If no, what is your other source of income? Are you applying for a franchise as individual, Corporation, Limited Liability Company or partnership? If Corporation or partnership include the copy of the Articles of Incorporation or Articles of Partnership What is your Federal Employer Tax Identification Number? What is your State Employer or Sales Tax Number? Location Preferences: Are you interested in a single franchise? If yes, please state specifics relating the city, county, state or a particular location you mat be interested in: YesNo First Choice State Second Choice State Third Choice State Are you interested in a Multi-Unit (min. 3 restaurants) Area Development Agreement? If yes, please state specifics relating to city, county, state or a particular location you may be interested in: YesNo First State Second State Third State If you wish to be considered as a franchise owner, please complete all the data requested on this franchise application, sign it, include your last three year's personal income tax returns and latest personal certified financial statement, along with a copy of your immigration status in the U.S.A., and return to Chicken Kitchen USA, LLC. By submitting this application you expressly acknowledge and agree that all banks, financial institutions, persons, firms, corporations referred in the above, are authorized to provide Chicken Kitchen USA, LLC, and/or any of its employees, agents and representatives, all information concerning the applicant for the purpose of determining financial and other qualifications. Chicken Kitchen USA, LLC is authorized to obtain a current credit bureau report in connection with this franchise application and if the undersigned becomes a Chicken Kitchen franchisee, to obtain periodic credit reports. Any material misrepresentations, furnished by the applicant in this franchise application or any other communication, shall be grounds by which Chicken Kitchen may immediately terminate any agreements executed by the undersigned and Chicken Kitchen USA, LLC. By submitting this application you certify and affirm to the best of your knowledge, that the foregoing franchise application and statements are true, factual, current and accurate representation of your financial and operational qualifications and background, and shall constitute a continuing representation. You hold Chicken Kitchen USA, LLC harmless for any damages arising from the verification of the information contained herin.