Please and save this form to your computer BEFORE

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Thank you for your interest in Mr. Pickle’s Sandwich Shop!
There are several aspects to our screening process that both parties will need to review and
agree upon to confirm a good fit for both you and Mr. Pickle’s Inc. (MPI).
A few questions that can help determine whether you are a good fit for a Mr. Pickle’s franchise:
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•
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•
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Are you passionate?
Are you able to follow a system?
Are you willing to work long hours?
Have you done your research on the business?
Do you know the market for your business?
Can you afford to buy and then have operating cash for the business?
Are you prepared to hire and manage people, often younger workers?
Are you ready to get involved in your community?
This is the first step of our ‘Administrative Screening Process’ which allows us to review the
following information:
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Employment History
Background Info
Educational background
Business and Personal References
Credit and Background Checks
In addition to the enclosed application, we will also need the following:
Copy of Driver’s License
Proof of Funding: 300-$400k minimum (submit copies of bank statements, 401K
statement, etc.,)
Submittal of the application does not obligate you to buy a Mr. Pickle’s franchise.
Please complete the application in full then email: [email protected]
or Mail to:
Mr. Pickle's Inc.
Attn: Sales Dept.
540 Auburn Ravine Road
Auburn, CA 95603
Company Confidential
10/15
v.6.0
Mr. Pickle's Inc.
540 Auburn Ravine Road
Auburn, CA 95603
Tel./Fax: 855-MRPICKLES
www.MrPickles.com
Once your application and required documents have been received by MPI, the Sales
Department will contact you to discuss your application and answer any initial questions you
may have. Next step is a meeting with our Sales Associate.
You will receive a Mr. Pickle’s Sandwich Shop Franchise Disclosure Document (FDD)
at the meeting with our Sales Associate. Please take the time to review this document in
great detail. We suggest also reviewing with legal counsel.
After all required paperwork has been submitted, and initial meetings have taken place, MPI
will determine if you should move on to our ‘Operational Screening Process’. During this
process you will be required to work in a Mr. Pickle’s Sandwich Shop for one week to ensure
you have a thorough understanding of day-to-day operations and a good working knowledge of
what Mr. Pickle’s is all about. During the Operational Screening Process, MPI will confirm
whether you are a good fit as a franchise candidate.
We appreciate your inquiry and look forward to our future meeting with you.
Please do not hesitate to contact our Sales Department at 855-MRPICKLES x700.
Thank you,
Mr. Pickle’s Inc.
Company Confidential
10/15
v.6.0
Mr. Pickle's Inc.
540 Auburn Ravine Road
Auburn, CA 95603
Tel./Fax: 855-MRPICKLES
www.MrPickles.com
Page | 2
Individual Application
Please answer all questions in detail. Do not use "See Resume' instead of completing the relevant sections. Attach
additional sheets if necessary. Please attach a resume for each equity partner(s) and/or operating partner(s).
Identifying Information
(Applicant #1)
Last Name
First Name
Date of Birth
Middle
Social Security Number
Work Phone #
Cell Phone #
Home Telephone #
Driver’s License # and State
Current Address
City
State
Zip Code
# of years?
Previous Address
City
State
Zip Code
# of years?
Fax #
E-mail Address
May we contact you at work?
Yes
Marital Status
Married
Single
Are you a U.S. Citizen?
Divorced
Widowed
No
Yes
Permanent Resident Alien? Yes
(attach copies)
A#
No
No
1551P
Passport #
Educational Background
(Applicant #1)
High
School
College or
Vocational
School
Graduate
School
Additional
Education
Military
Experience
Extra
Training or
Skills
Name of School & Location
Completed?
Yes
Name of School & Location
No
Degree?
Yes
Name of School & Location
No
Degree?
Yes
No
Describe:
Branch of Service
Highest Rank achieved
Dates of Service
Discharge Status
Describe:
Company Confidential
10/15
v.6.0
Mr. Pickle's Inc.
540 Auburn Ravine Road
Auburn, CA 95603
Tel/Fax: 855-MRPICKLES
www.MrPickles.com
Page | 1
Employment History
(Applicant #1)
Current Employer
Address
City
State
Employment Dates?
Zip Code
From:
Job Title
Starting Salary
Ending Salary
Supervisor's name and title
Reason for leaving:
Supervisor's Contact #
Job Title
May we contact?
Yes
No
Telephone #
Previous Employer
Address
To:
State
City
Starting Salary
Ending Salary
Zip Code
Reason for leaving:
Supervisor's Contact #
Supervisor's name and title
Employment Dates?
From:
To:
Previous Employer
May we contact?
Yes
No
Telephone #
Address
City
Job Title
Starting Salary
State
Ending Salary
Supervisor's name and title
Zip Code
Reason for leaving:
Supervisor's Contact #
Employment Dates?
From:
To:
May we contact?
Yes
No
Other Background Information
(Applicant #1)
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? Yes
No
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? Yes
No
If yes, please explain:
No
Been adjudicated bankrupt or reorganized due to insolvency? Yes
Are you a cosigner or guarantor of any other debt?: ? Yes
No
If yes, please explain:
If yes, please explain:
Any additional information we should know:
Company Confidential
10/15
v.6.0
Mr. Pickle's Inc.
540 Auburn Ravine Road
Auburn, CA 95603
Tel/Fax: 855-MRPICKLES
www.MrPickles.com
Page | 2
Identifying Information
(Applicant #2)
Last Name
First Name
Date of Birth
Home Telephone #
Middle
Social Security Number
Work Phone #
Cell Phone #
Driver’s License # and State
Current Address
City
State
Zip Code
# of years?
Previous Address
City
State
Zip Code
# of years?
E-mail Address
Fax #
Marital Status
Married
Are you a U.S. Citizen?
Single
Divorced
Widowed
Yes
No
May we contact you at work?
Permanent Resident Alien? Yes
(attach copies)
A#
Yes
No
No
1551P
Passport #
Educational Background
(Applicant #2)
High
School
College or
Vocational
School
Graduate
School
Additional
Education
Military
Experience
Extra
Training or
Skills
Company Confidential
10/15
v.6.0
Name of School & Location
Completed?
Yes
No
Degree?
Name of School & Location
Yes
Name of School & Location
No
Degree?
Yes
No
Describe
Branch of Service
Highest Rank achieved
Dates of Service
Discharge Status
Describe:
Mr. Pickle's Inc.
540 Auburn Ravine Road
Auburn, CA 95603
Tel/Fax: 855-MRPICKLES
www.MrPickles.com
Page | 3
Employment History
(Applicant #2)
Current Employer
Address
Job Title
Telephone #
State
City
Starting Salary
Ending Salary
Zip Code
Reason for leaving:
Supervisor's Contact #
Supervisor's name and title
Job Title
May we contact?
Yes
Previous Employer
Address
Employment Dates?
From:
To:
Telephone #
City
Starting Salary
State
Ending Salary
Zip Code
Reason for leaving:
Supervisor's name and title
Supervisor's Contact #
Employment Dates?
From:
To:
May we contact?
Yes
Job Title
No
Telephone #
Previous Employer
Address
No
State
City
Starting Salary
Ending Salary
Zip Code
Reason for leaving:
Supervisor's name and title
Supervisor's Contact #
Employment Dates?
From:
To:
May we contact?
Yes
No
Other Background Information
(Applicant #2)
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? Yes
No
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? Yes
No
If yes, please explain:
No
Been adjudicated bankrupt or reorganized due to insolvency? Yes
Are you a cosigner or guarantor of any other debt?: ? Yes
No
If yes, please explain:
If yes, please explain:
Any additional information we should know:
Company Confidential
10/15
v.6.0
Mr. Pickle's Inc.
540 Auburn Ravine Road
Auburn, CA 95603
Tel/Fax: 855-MRPICKLES
www.MrPickles.com
Page | 4
Your Plans for a Mr. Pickle's Sandwich Shop
Location
Preference
Location #1
Location #2
Location #3
If you are making an offer on an existing unit, please list the city?
If you are making an offer on an existing unit, please list sales price:
Number of shops you would like to develop?
Year 1:
Do you plan to devote your full time to this venture? Yes
Year 2:
No
Year 3:
Year 4:
Year 5:
If not, please explain:
Do you plan on continuing your current employment after purchasing this franchise? Yes
No
If yes, please explain:
How will you finance this franchise investment? What are the total funds available?
Do you plan to have equity partners in this franchise? Yes
No
If yes, who will they be and what are their contributions?
Do your currently own / operate any other franchise or business? Yes
No
Will your spouse or other family members be active in the franchise? Yes
If yes, please list all details:
No
If yes, please explain:
Will there be another primary contact person? If so, please list their name and preferred contact number / e-mail:
If approved, who will be the person setting up administrative aspects of opening their franchise? (i.e. business license, setting up vendor
accounts, etc.)
Should all parties be copied on all e-mail communication?
Yes
No
Any additional information we should know:
Company Confidential
10/15
v.6.0
Mr. Pickle's Inc.
540 Auburn Ravine Road
Auburn, CA 95603
Tel/Fax: 855-MRPICKLES
www.MrPickles.com
Page | 5
References
Name of Bank or Supplier
Address
(Business References)
Telephone #
City
State
Zip Code
Name of Bank or Supplier
Address
Telephone #
City
State
Zip Code
Name of Bank or Supplier
Address
Contact Name?
Contact Name?
Telephone #
State
City
Zip Code
Contact Name?
References
(Personal and Character References)
Name
Occupation
Address
City
State
Name
Zip Code
Telephone #
Occupation
Address
State
City
Name
Zip Code
Telephone #
Occupation
Address
State
City
Zip Code
Telephone #
I certify, the information contained herein is true and accurate to the best of my knowledge.
I understand that this application once submitted to Mr. Pickle's Inc. is valid for 90 days. If an
application is not accepted within 90 days an updated application package must be submitted.
If any of the information outlined in this application changes, applicant is responsible for
informing Mr. Pickle's Inc. of the changes immediately.
Print
Name & Date
Signature (Applicant #1)
Print Name & Date
Signature (Applicant #2)
Please complete the application in full then scan, fax or mail ‘Attention-Sales Department’:
E-mail: [email protected]
Company Confidential
10/15
v.6.0
Mr. Pickle's Inc.
540 Auburn Ravine Road
Auburn, CA 95603
Tel/Fax: 855-MRPICKLES
www.MrPickles.com
Page | 6
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 Inc. in any manner, nor
does it imply that there is any legal or commercial relationship between either party. I acknowledge that Mr. Pickle's Inc.
reserves the sole right to approve or disapprove this application for any reason it may determine, and in the event the Mr.
Pickle's Inc. disapprove 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 Mr. Pickle's Inc. 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 Mr. Pickle's Inc. 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 Mr. Pickle's
Inc. and provided the name of the Consumer Reporting Agency. I agree that this release shall be valid in photocopied
form.
The undersigned authorizes Mr. Pickle's Inc. to obtain business reports, perform credit and background / criminal checks
on the applicant's legal entity and/or individuals where Mr. Pickle's Inc. deems applicable.
I certify that the information supplied by me is true and correct.
Applicant #1:
Print Name
Applicant Signature
Date
Applicant #2:
Print Name
Applicant Signature
Date
Company Confidential
10/15
v.6.0
Mr. Pickle's Inc.
540 Auburn Ravine Road
Auburn, CA 95603
Tel/Fax: 855-MRPICKLES
www.MrPickles.com
Page | 7
Individual Application
Confidentiality and Proprietary Information Agreement
I hereby acknowledge that all the information related to methods of operating Mr. Pickle's Sandwich Shops, building
plans, equipment, supplies, suppliers, costs, recipes, system standards, training manuals, videos, and profit information,
and any other information relating to the business interest of Mr. Pickle's Inc revealed to me in connection with my
application to become a franchisee, is a trade secret, confidential, and proprietary information wholly owned by Mr.
Pickle's Inc. 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 Mr.
Pickle's Inc.
I further agree that all written materials, drawings, instruments or documents of any type which I may receive from Mr.
Pickle's Inc. shall remain the property of Mr. Pickle's Inc. and that these items are loaned to me by Mr. Pickle's Inc. 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 or trade name or trade dress rights
in the marks of Mr. Pickle's Inc. or marks similar thereto, and I shall not use any such marks except as authorized under
the Franchise Agreement.
Applicant #1:
Print Name
Applicant Signature
Date
Applicant #2:
Print Name
Applicant Signature
Date
Please complete the application in full then email to: [email protected]
or
Print and mail to:
Mr. Pickle's Inc.
Attn: Sales Department
540 Auburn Ravine Road
Auburn, CA 95603
Company Confidential
10/15
v.6.0
Mr. Pickle's Inc.
540 Auburn Ravine Road
Auburn, CA 95603
Tel/Fax: 855-MRPICKLES
www.MrPickles.com
Page | 8
PERSONAL FINANCIAL STATEMENT
As of
,
Complete this form for: (1) each proprietor, or (2) each limited partner who owns 20% or more interest and each general partner, or (3) each stockholder owning 20% or
more of voting stock, or (4) any person or entity providing a guaranty o n the loan. MPI may at it's discretion request additional and/or more detailed information.
Name
Business Phone
Residence Address
Residence Phone
City, State, & Zip Code
Business Name of Applicant/Borrower
ASSETS (attach recent statements)
(Omit Cents)
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 and 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
Section 1.
$
$
(Omit Cents)
$
Accounts Payable
Notes Payable to Banks and Others
(Describe in Section 2)
Installment Account (Auto)
Mo. Payments
$
Installment Account (Other)
Mo. Payments
$
Loan on Life Insurance
Mortgages on Real Estate
(Describe in Section 4)
Unpaid Taxes
(Describe in Section 6)
Other Liabilities
(Describe in Section 7)
Total Liabilities
Net Worth
$
$
$
$
$
$
$
$
$
Total
$
Contingent Liabilities
Source of Income
Salary
Net Investment Income
Real Estate Income
Other Income (Describe below)*
LIABILITIES
$
$
$
$
As Endorser or Co-Maker
Legal Claims & Judgments
Provision for Federal Income Tax
Other Special Debt
$
$
$
$
Description of Other Income in Section 1.
*Alimony or child support payments need not be disclosed in "Other Income" unless it is desired to have such payments counted toward total income.
Section 2. Notes Payable to Banks, Finance Companies, Credit Cards and Others.
(Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.)
Original
How Secured or Endorsed
Current
Payment
Frequency
Name and Address of Noteholder(s)
Balance
Amount
(monthly,etc.)
Balance
Type of Collateral
Company Confidential
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Section 3. Stocks and Bonds. (Use attachments if necessary. Each attachment must be identified as a part of this statement and signed).
Market Value
Date of
Number of Shares
Name of Securities
Cost
Total Value
Quotation/Exchange Quotation/Exchange
(List each parcel separately. Use attachment if necessary. Each attachment must be identified as a part
of this statement and signed.)
Property A
Property B
Property C
Section 4. Real Estate Owned.
Type of Property
Address
Date Purchased
Original Cost
Present Market Value
Name &
Address of Mortgage Holder
Mortgage Account Number
Mortgage Balance
Amount of Payment per Month/Year
Status of Mortgage
Section 5. Other Personal Property and Other Assets.
Section 6.
Unpaid Taxes.
Section 7.
Other Liabilities (descibe in detail)
Section 8.
Life Insurance Held.
(Describe, and if any is pledged as security, state name and address of lien holder, amount of lien, terms
of payment and if delinquent, describe delinquency)
(Describe in detail, as to type, to whom payable, when due, amount, and to what property, if any, a tax lien attaches.)
(Give face amount and cash surrender value of policies - name of insurance company and beneficiaries)
I authorize Mr. Pickle's Inc. to make inquiries as necessary to verify the accuracy of the statements made and to determine my creditworthiness. 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 Mr. Pickle's Inc. is relying upon this information in considering my applican and
Mr. Pickle's Inc. may terminate the franchise or loan application if there are any misrepresentations or material omission on this application.
Signature:
Date:
Signature:
Date:
PLEASE NOTE:
If any of the information outined in this application changes, applicant is responsible of informing MPI of the changes immediately. I understand that
this application once submitted to MPI is valid for 90 days. If an application is not accepted within 90 days, an updated application package must be
submitted.
Company Confidential
10/15
v.6.0