Return all Documents to: Konefood, LLC387 NE 167th St North Miami Beach, Florida 33162 Fax: 404-420-2345 Email:

[email protected]
A completed application is required from all equity partners with ownership interest

______________________ ________________ Name Social Security # ______________________ ________________ Spouses Name Social Security # _______________________________________ Street Address ______________________ _________________ Home Phone Office Phone

______________ _______________________ Date of Birth Citizenship _______________ ______________________ Date of Birth Citizenship ____________ _________________________ City State Zip _______________ ______________________ Cell Phone E-Mail Address

Confidential: This application does not obligate either party in any manner. Authorization to Release Information
I, the undersigned, _______________________, having made application to Konefood, for the issuance of a Konefood Franchise (Franchise) to me, or to ____________________________ (the Company), a proprietorship ( ), partnership ( ), or corporation ( ), of which I as the/a proprietor ( ), partner ( ), office ( ), director ( ), or beneficial owner of 10% or more of the equity/capital stock ( ), (check each applicable item), hereby authorize Konefood or such agents or designees as Konefood may from time to time appoint, to make such inquiries and to do such investigation as may be deemed necessary or appropriate to verify information given by me concerning my present or past employment, businesses, credit and financial history, education, and character and reputation. I hereby authorize and direct any and all persons having knowledge of me and/or any of the aforementioned matters as they relate to me, or such information as they may think relevant to consideration of my application, to release such information to Konefood or its agent or designee. I specifically authorize and direct any and all departments or agencies of government, whether federal, state, or local, including any and all law enforcement agencies, to accept this or a photo static reproduction hereof as my authorization to release information to Konefood or its agents or designee information concerning me, including, but not limited to records of any arrest or detention, military personnel records, records of licensure or registration and, any and all applications, background reports, or regulatory files kept or received in connection with such licensure or registration, or any other information pertaining to me as though such information were being released to me. I release each and every department or agency which may be requested to, or which does furnish information about me from any requirement to notify me of presentation of such request or release present to this authorization, or a photo static reproduction hereof, except where may be required by law. I understand that investigation of me may touch upon or include requests for information concerning my character, credit, personal habits and associates now, or in the past. I further understand that information about me may be reviewed, reevaluated, or up-dated from time to time. I agree that if Konefood shall grant a Franchise to me or the Company, this authorization shall remain in full force and effect for as long as the Franchise shall remain extant. I certify that I have read each of the provisions of this Authorization and understand each provision. THE UNDERSIGNED certifies that the information supplied on this form and any financial information submitted on other forms is true and correct.

_____________________________________ Signature (Applicant) Date

__________________________________________ Signature (Spouse) Date

Miscellaneous Information:
Yes
Have you ever been convicted of anything other than traffic violations? Has any judgment ever been made against you or your company or your employer where you were one of the litigants? Are you involved in pending litigation? If you answered yes to any of these questions, please attach detailed information. Have you or your spouse ever declared bankruptcy? If yes, please attach detailed information. Have you ever owned your own business or franchise? If yes, please attach detailed information. Have you ever had a business failure? If yes, please attach detailed information. Are you or your employer providing products, goods or services to Konefood or to franchisees of Konefood? If yes, please attach detailed information. Will you devote your full time to this business? Are you willing to relocate for a franchise opportunity? Please indicate where you obtained Konefood s contact information. Please be specific. Konefood Other Trade Show I Website ____________________ Website ___________________ Google__________________ Conference ____________________ Direct Mail __________________ Radio _________________ TV ___________________
Konefood

No

Magazine

________________________

Restaurant ___________________ Referral ___________________ Other __________________________________________________

New Build Geographic Interest First Choice Address/ Area City State Zip Property Yes Owned

2nd Choice Address/ Area City State Zip Property Owned Address/ Area City State Zip Property Owned

3rd Choice

No

Yes

No

Yes

No

Venue Type (Due to current development priorities, some venue types may not be available in all areas) Freestanding _________________________________ Captive Audience (Mall, airport, University) ______________________

In / Strip Center _________________________________

Buy Stores Geographic Interest Please check/ list the areas you are interested in buying City County State Region DMA Please check the number of stores you are looking at buying 1-2 3-5 6 - 10 10 +

Do you have a Lending Institute in place for buying stores?

Yes ______

No _______

If yes, please list mane of Lending Institute: __________________________________________________________________________ _______________________________________________________________________________________________________________

Education Last year of school completed

Name of College or post graduate school

Degree

Current Occupation Please attach resume if available Company Current Salary

Position Address

Dates Employed

Describe duties, number of employees supervised and responsibilities

Previous Business Experience (list most recent first) Occupation Company

Position Address

Dates Employed Reason for leaving

Describe duties, number of employees supervised and responsibilities

Occupation Company

Position Address

Dates Employed Reason for leaving

Describe duties, number of employees supervised and responsibilities

Food Service Experience Concept, Year of Tenure, Titles, Principal Responsibilities Please be specific

Personal Financial Statement

To obtain credit approval for a Konefood Agreement; you, or your partnership, must have $100,000 in verified liquid assets and a minimum net worth of $500,000. Verification includes current bank, mutual fund, or brokerage statements (No older than 90 days). We will not be able to approve your application if these criteria are not met, or if the documentation is incomplete.
Liquid Assets Cash on hand and in the banks Account Account Account Account Account Cash surrender Value Life Insurance IRA, 401K, and Retirement Funds Total Liquid Assets Non-Liquid Assets
Notes, Accounts, and Mortgages Receivables

$ $ $ $ $ $ $ $ $

Liabilities Loans/notes/accounts payable Federal or State Taxes Due Real Estate Mortgages Loans against Life Insurance Other Liabilities

Total Liabilities (B) Net Worth Total Assts (A) Less Total Liabilities (B) Equals Net Worth

$ $ $ $ $ $ $ $ $

Real Estate Owned Net Value of Business Interest

$ $ $ $ $ $

$ $ $ = $

Total Non- Liquid Assets

Liabilities Schedule Notes/ Accounts/ Mortgages Payable (Maturity Date beyond 12 months) Monthly Description of Debt Payments Current Balance

Lending Institution

Mail or fax completed application and all requested documentation to: Konefood LLC. 387 NE 167th. St North Miami Beach, Florida 33162 Fax: 404-420-2345 email: [email protected]