Franchise Application

PERSONAL INFORMATION
Your Full Name*
Current residence address*
Home phone*
City/State/Zip Code*
Business phone*
Best number to call*
Social Security #*
Date of Birth*
E-mail address*
Spouse's Name
Last four numbers of Spouse's SSN
Please tell us how you became aware of Society Wine Bar (e.g., magazine, referral, Internet site, store visit, etc.).*
BUSINESS EXPERIENCE
Present Occupation*
Position*
Dates employed*
Do you have any wine, restaurant, hospitality or retail experience If so, tell us about it.*
Do you have any other business experience you believe may be helpful to this franchise?*
Have you ever owned your own business, franchise or been self-employed? If so, tell us about it.*
Why do you want to own a Society Wine Bar? If you are granted a franchise, when would you like to open?*
In what city do you propose to locate your Wine Bar?*
Have you identified a site? If so, describe.*
Do you plan on financing any portion of your franchise?*
Do you have access to the funds needed to open a Society Wine Bar Franchise?*
Will you have other partners or investors in the business?*
Financial Information
Assets
Liabilities
Checking & Savings*
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Notes payable - Banks*
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Marketable Securities*
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Notes payable - Other*
Non-Marketable Securities*
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Real estate mortgages payable (Home)*
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Real Estate Owned*
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Real estate mortgages payable (Other)*
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Other Assets*
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Other Debts*
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Other Assets (Explain)*
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Other Debts (Explain)*
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Total Assets*
Total Liabilities*
Net Worth*
Total Assets & Net Worth*
Total Household Income
Source*
Amount*
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Other Financial Information
Please provide any other financial data you think is pertinent.*
Upload any financial statements here.
Drop files here or

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Maximum File Size Limit is 64MB. Maximum number of files is 5.
I/we understand that Society Wine Bar, LLC (“Society Wine Bar”) will rely on the information provided herein in deciding whether to grant a Society Wine Bar Franchise. I/we represent and warrant that the information provided is true and complete, and that Society Wine Bar may consider this information to be true and correct unless I/we give written notice to the contrary. I/we authorize Society Wine Bar to make all inquiries deemed necessary to verify the accuracy of the statements made herein, including but not limited to, a consumer credit report and criminal background check to determine my/our financial condition and suitability for a Society Wine Bar Franchise. I/we authorize the release to Society Wine Bar, upon presentation of this document or a copy thereof, any all-encompassing information concerning my/our background, financial and/or credit history.

Maine, Massachusetts, and New Jersey applicants or employees only: You have the right to inspect and promptly receive a copy of any investigative consumer report requested by Society Wine Bar by contacting the consumer reporting agency identified above directly.

Minnesota applicants or employees only: You have the right, upon written request to Agency, to receive a complete and accurate disclosure of the nature and scope of any consumer report. Agency must make this disclosure within five days of receipt of your request or of Society Wine Bar request for the report, whichever is later.

New York applicants or employees only: You have the right to request whether Society Wine Bar requested a consumer report and, if so, Society Wine Bar will give you the name and address of the report's provider if other than Agency.

California, Minnesota and Oklahoma applicants or employees only: Please check this box if you would like to receive from Agency a copy of any report furnished by Agency to Society Wine Bar pursuant to your authorization below.

Washington applicants or employees only: Society Wine Bar will provide the disclosure described above concerning its procurement of an investigative consumer report either five days after receiving your request or after requesting the investigative consumer report, whichever is later. You have the right to ask Society Wine Bar to provide you with a summary of your rights under the Washington Fair Credit Reporting Act.
Acknowledgement*
- I acknowledge that I have completed this application and grant permission to Society Wine Bar to complete a background / credit check.
Your Signature*