Please return the confidential completed application

to our Franchise Coordinator

via fax: 972.619.6056
via email: franchising@nestlecafe.com

Franchise Application
NTHC Representative (If known):

City / State / Location Preference: __________________________________________________________

First Name: _________________________Middle Initial:_______Last Name:_______________________
Residence Address:_____________________________________________City:____________________
State:________________________________Zip:_____________________________________________
Residence Phone:______________________Mobile Number:____________________________

Email Address:______________________________________Date of Birth:_________________________

Previous Address if Less than 5 Years at Current:______________________________________________
_____________________________________________________________________________________
Social Security Number:_________________DL Number / State:__________________________
Every Convicted of a Felony Yes No If Yes, Charge:______________________________________
Ever a Debtor in a Bankruptcy? Yes No If Yes, What Year:_________________________________
Are You Married Yes No Name of Spouse:_____________________________________________
Spouse's Social Security Number:__________________________________________________________
Yes No - I am a citizen of a country which is currently prohibited law, executive order or
otherwise, from conducting business with or owning a business in the United States.
Yes No - Do you or anyone in your family have any foodservice experience If yes, please
provide
details:_______________________________________________________________________
_____________________________________________________________________________
______________
Yes No-Are you or anyone in your family under any form of non-competition agreement that
limits your right to operate any business? If Yes, Please provide details:
_____________________________________________________________________________
_____________________________________________________________________________
________________
Yes No-Will there be other Partners / Owners? If Yes, Each Partner / Owner must complete
an individual application.
Yes No-Do you intend to operate the business yourself? If No, Who will be the responsible
party? _______________________________________________________________________

Please return the confidential completed application

to our Franchise Coordinator
via fax: 972.619.6056
via email: franchising@nestlecafe.com

Personal References

Name:_______________________________Address:__________________________________________
City:__________________State:_____Zip:___________________Phone:__________________________
Email:______________________________________Years Known:_______________________________

Name:_______________________________Address:__________________________________________
City:__________________State:_____Zip:___________________Phone:__________________________
Email:______________________________________Years Known:_______________________________

Name:_______________________________Address:__________________________________________
City:__________________State:_____Zip:___________________Phone:__________________________
Email:______________________________________Years Known:_______________________________
Education
High School:_________________________City/State/Country:___________________________
Major Course of Study:________________________________Year Graduated:______________
College:_________________________City/State/Country:______________________________
Major Course of Study:________________________________Year Graduated:_______________
Graduate School:_________________________City/State/Country:___________________________
Major Course of Study:________________________________Year Graduated:______________
Other:_________________________City/State/Country:________________________________
Major Course of Study:________________________________Year Graduated:______________
Professional Experience. Resumes Accepted in Lieu of Completing this Section
Name of Company:_________________________City/State/Country:___________________________
Last Position Held:__________________Primary Responsibilities:________________________
Reason for Leaving:_____________________________Employed To / From:_______________
Name of Company:_________________________City/State/Country:___________________________
Last Position Held:__________________Primary Responsibilities:________________________
Reason for Leaving:_____________________________Employed To / From:_______________
Name of Company:_________________________City/State/Country:___________________________
Last Position Held:__________________Primary Responsibilities:________________________
Reason for Leaving:_____________________________Employed To / From:_______________
Name of Company:_________________________City/State/Country:___________________________
Last Position Held:__________________Primary Responsibilities:________________________
Reason for Leaving:_____________________________Employed To / From:_______________

Please return the confidential completed application

to our Franchise Coordinator
via fax: 972.619.6056
via email: franchising@nestlecafe.com

Professional Affiliations

Name of Organization:_________________________City/State/Country:___________________________
Member Since:_________________Primary Responsibilities:____________________________

Name of Organization:_________________________City/State/Country:___________________________
Member Since:_________________Primary Responsibilities:____________________________

Name of Organization:_________________________City/State/Country:___________________________
Member Since:_________________Primary Responsibilities:____________________________
Personal Financial Information
Assets
Liabilities
Liquid Assets:
Pubic Stocks
Bonds
CDs
Mutual Funds
Cash
Other
Sub Total

Notes Payable
Mortgage
Car Loan
Other
Sub Total
Other Liabilities
Taxes
Credit Cards

Other Assets
Judgments
Real Estate
Liens
Personal Property
Alimony
Private Stock
Child Support
Other
Other
Sub Total
Sub Total
Total Assets
Total Liabilities
Net Worth/ Total Assets - Total Liabilities:
Yes No I have enough income to maintain my current lifestyle without spending funds
allocated for developing my Nestle Toll House Caf by Chip franchise(s) until opening.
Release and Liability
I certify that the information provided to Nestle Toll House Cafe by Chip is true and correct. I
authorize Nestle Toll House Caf by Chip to verify the information I have provided on this and
any attached forms including, but not limited to: a credit report, background check and bank
statements, which are obtained prior to awarding a franchise license. I hold Nestle Toll House
Caf by Chip harmless for any damages arising from the verification of this or other information I
have provided.
Signed by:___________________________Title:__________________________Date:____________