加盟合作申请意向表.doc

Global Business Development全球商业发展REQUEST FOR CONSIDERATION FORM加盟合作申请意向表The information requested in this form is used to evaluate your qualifications to be awarded a Papa Johns franchise. (Please print or type your responses.)该表所要求填写的信息用以评估是否具备加盟棒！约翰的资格。（请打印表格内容）PERSONAL DATA个人信息Name: Date of Birth:姓名： 出生日期：Social Security, Passport or Country ID Number: _社保号、护照号或身份证号：Address: _地址：State, Country, Zip Code: Citizenship:国家省份邮编： 国籍：Email Address: _电子邮件地址：Home Telephone:_ Business Telephone:家庭电话： 单位电话：Mobile Telephone:_ Facsimile:手机： 传真：Marital Status:_ Spouses Name: 婚姻状况： 配偶姓名：What specifically drove you to contact Papa Johns at this time? (Please be specific as to the exact newspaper, magazine, etc.)这一次是什么促使您联系棒！约翰？（请注明报纸、杂志等名称）Area(s) of Interest: Number of Units You Wish to Develop:有意向的区域： 希望开设店铺数量：1. _ _2. _ _BUSINESS EXPERIENCE商业经验 Please list present or most recent company information.请列举目前或最近公司信息。Company Name:公司名称：Type of Business:企业类型：Address:地址：Papa Johns International, Inc. Request for Consideration FormPage Two棒！约翰国际有限公司加盟合作申请意向表第2页Present / Most Recent Position: 目前/最近职位：Dates Position Held: 任职日期：Number of People You Directly Manage:直接管理人数：Previous Positions: 之前职位：Have You Ever Owned a Business? Yes No 是否曾经拥有过一家企业？ 有 无If Yes, What Type of Business?如果有，是什么企业类型？Do You Plan to Devote Full Time to This Business Venture? Yes No您是否计划全职经营这次商机？ 是 否Will You Have Equity Partners? Yes No您是否有股东合伙人？ 是 否(If yes, please identify all partners in the Business Structure section of this form.)（如果是，请在本表格的商业结构栏中写明所有合伙人。）Why do you believe you can successfully operate a Papa Johns franchise in your area(s) of interest?您为何认为自己能够在所意向区域成功经营棒！约翰？Additional information you would like to share with us in evaluating your Request for Consideration form: 愿意提供用来评估申请意向表的其他信息：Are you now, or have you in the previous ten years, been a Yes Noparty to any lawsuit, arbitration, mediation, bankruptcy or other legal proceeding?您目前或在前十年内是否参与任何诉讼、裁决、调解、破产或其他法律诉讼？ 是 否If yes, please provide details:如果是，请提供细节： _Have you ever been convicted of a felony? Yes No您是否曾犯有重罪？ 是 否If yes, please provide details:如果是，请提供细节：Papa Johns International, Inc. Request for Consideration FormPage Three棒！约翰国际有限公司加盟合作申请意向表第3页PERSONAL FINANCIAL STATEMENT个人财务报告Personal Financial Statement as of:个人财务报告，自（日期）：Name:姓名：Address:地址：Social Security Number or other Country ID Number: 社会保险编号或其他国家身份证号：Assets:资产：Amount in US $:以美元计：Cash - checking accounts现金活期存款Cash - savings accounts现金储蓄存款Certificates of deposit存款单Securities - stocks / bonds / mutual funds有价证券股票/债券/共同基金Notes & contracts receivable应收票据和契约Automobiles汽车Vested interest in defferred compensation/profit sharing plans递延补偿/利益分配计划中的既得利益Real estate (market value)房地产（市值）Other assets (specify)其他资产（请注明）Other assets (specify)其他资产（请注明）Total Assets:总资产：Liabilities:债务：Amount in US $:以美元计：Current Debt (Credit cards, Accounts)目前债务（信用卡、账单）Notes payable (describe below)应付票据（在下面描述）Taxes payable应付税款Real estate mortgages (describe)房地产抵押（请描述）Other liabilities (specify)其他债务（请注明）Other liabilities (specify)其他债务（请注明）Total Liabilities:总债务：Net Worth:资产净值：Papa Johns International, Inc. Request for Consideration FormPage Four棒！约翰国际有限公司加盟合作申请意向表第4页PROPOSED COMPANY STRUCTURE 规划公司结构A. Proposed Owner(s):计划所有者： Name:Address:Social Security Number: Active in Franchise? 姓名： 地址： 社会保险编号： 目前是否有特许经营？1. _2. _3. _B. Proposed Principal Operator:建议主要经营者： Name:Address:Social Security Number: 姓名： 地址： 社会保险编号：C. What will be your companys organizational structure (e.g., Partnership, Corporation, LLC, etc.)? 您将采取何种公司结构（如合伙公司、股份有限公司、有限责任公司等）？D. If lender financing, please name specific resources: 如贷款，请注明贷款来源：E. Please attach a resume or C.V. and financial statement for each proposed owner and your Principal Operator candidate.请附上每位计划所有者和主要经营者申请人的简历和财务报表。 ACKNOWLEDGEMENT 确认By signing and submitting this form to Papa Johns International, Inc., you hereby authorize Papa Johns International, Inc. and or its agent to perform background checks including obtaining your consumer credit report from a credit reporting agency. Your signature also authorizes, without reservation, any agencies contacted to furnish your consumer credit information and release all parties involved from any liability and responsibility for doing so. This authorization and consent shall be valid in an original, fax, photocopy or digital image form.签署并向棒！约翰国际有限公司递交此表格，即授权棒！约翰国际有限公司及/或其代理机构授权对您进行背景调查，包括从征信机构获得消费信用