Date McDonald's Corporation Application for a Franchise Confidential This application does not obligate either party in any manner. Applicant's name 2"x2" Photo PERSONAL INFORMATION Name Residence Business address Business phone Tax Identification number Home phone May we contact you at your business phone? Social Security Number Date of birth Spouse's name Date and purpose of last physical exam Height Name and ages of children Weight Marital status Total dependents Describe any physical disabilities or limitations Have you ever been convicted of anything other than minor traffic violations?
Has any judgment ever been entered against you or your company or your employer where you were one of the litigants? Are you involved in pending litigation? Have you ever declared personal bankruptcy?
If yes, explain. Citizenship EDUCATION Last year of school completed Name of college and lor postgraduate school Degree Describe any training in sales, management or retailing BUSINESSEXPER~NCE Present occupation Company Describe duties, number of employees supervised and responsibilities Position Address Dates Employed Previous business experience (Give exact names, address and dates. List most recent first.) Dates employed Address Responsibilites Dates employed Address Responsibilities Pagelof5 Position Position Company Name of supervisor Company Name of supervisor Type of business Reason left Type of business ... more. less.
Reason left Dates employed Address Responsibilities Dates employed Address Reqponsibilities Position Position Company Name of supervisor Company Name of supervisor Type of business Reason left Type of business Reason left Have you ever been self-employed?<br><br> If so, explain. Have you ever had a business failure? If so, explain.<br><br> PERSONAL FINANCIAL STATEMENT Salary, wages P Bonus, commissions Dividends, interest Real estate income Business profits Notes/accounts receivable Other income--specify source, e.g. trust, spouse, etc. TOTAL Please provide details on the following asset verification schedules (schedule numbers in parentheses).<br><br> Assets Cash on hand and in banks F Vested profit sharing Securities (1) Bonds/debentures (2) Notes, accounts and mortgages Real estate--CU/Tent market value Net value of business interests (8) Other--automobiles and other DroDertv. etc. (5) Total assets Liabilities Note/IDans payable to banks 1 Notes/loans payable to friends, Accounts and bills payable (4) Real estate mortgages (7) Other debts or obligations (6) Total liabilities Net worth Total liabilities and worth Give names of banks or finance companies where accounts are carried or where credit can be obtained or verified.<br><br> Name Address Highest extended credit Purpose Can you personally meet the McDonald's financial requirements? From what sources? Page2of5 ASSET VERIFICATION SCHEDULES (1) Listed securities No.<br><br> Pledged Current shares Description yes/no mkt. value Total p (3) Notes/accounts/mortgages receivable Total (4) Loans/notes/accountslbills payable (excluding mortgages) Total (5) Other Asstes (e. g.: Stock options, cash value of life insurance, automobiles and other personal property, etc.) Description Current fair mkt.<br><br> value Total p Page3 of5 Total Total Current mkt. value p Present balance p (2) Bonds/debentures (6) Other debts and liabilities (e.g.: Insurance loans, alimony, child support, leases, contracts, legal claims, judgements, chattel motgages, taxes, comaker or guarantor, etc.) p p ASSET VERI ICA TlON SCHEDULES Continued (7) Real estate Address and description of property (residential, rental, vacant) Date Title in acquired name(s) of Original cost Original mortgage amount Mo. payments Current (incl.<br><br> taxes, Current mortgage assessments market value balance Net valu (8) Business Interests Business Address N, . D Type (partner, corp., ,Ie) Name of all owners Relation to applicant Buy/sell Percent agreement equity Valuation method (book, earnings multiple, appraisal, dvalue) Net value your Tota p Does your spouse or another person have any interest in any of the above assets? If yes, please explain and list assets.<br><br> Have any of the above assets been acquired by you as a gift? If yes, specify assets. Fromwhom?<br><br> When? Personal references (other than employers or relatives) Name in full Address Telephone No. Occupation Years Known Name in full Address Telephone No.<br><br> Occupation Years Known Address . Telephone7vo. Occupation' Years Known Name in full Page40fS List any hobbies, community activities, special interests or other pertinent information Are you related by blood or marriage to any officer of McDonald's Corporation and/or Golden Arches Development Corporation and/or McGeorge Food Industries Inc.<br><br> ? Name Relationship Are you or your employer providing products, goods or services to McDonald's or franchisees of McDonald's? If yes, please attach detailed information.<br><br> Will you devote you full time to this business? Which geographical areas are you interested in? Have you ever worked in a McDonald's restaurant?<br><br> If so, where and when? Have you ever applied for a McDonald's franchise? If so, where and when?<br><br> "I submit the foregoing information as my complete and true personal and financial condition as of the date shown below. I expressly authorize any past or present employer, any law enforcement agency, national or local, or any person who has personal knowledge of my character, work experience or criminal records to release this information to McDonald's Corporation and/or Golden Arches Development Corporation (GADC). If requested by McDonald's Corporation and/or GADC, I agree to supply statements from any professional advisors (i.e.<br><br> banker, broker, accountant or attorney) verifying the above assets, and I also agree to furnish copies of Income Tax Returns as filed for the last five years. I understand that McDonald's Corporation and/ or GADC is relying upon all the above information as a material factor in considering my application to become a McDonald's franchisee, and I therefore agree to promptly notify McDonald's Corporation and/or GADC of any material change in any of the above information or any subsequent information provided to McDonald's Corporation and/or GADC. In addition, I release all persons from liability as a result of true, accurate Information." Signature (Applicant) Signature (Spouse) Page 5 of5 MeD 18837A-I/91 Date Date<br><br>