Great Plains Pizza Company PRELIMINARY INFOMATION QUESTIONNAIRE Please provide the following information to assist Great Plains Pizza Co. in evaluating your qualifications for ownership of a Great Plains Sauce & Dough Company franchise. Completion of this Questionnaire imposes no obligation whatsoever on you or Great Plains Pizza Co. All information will be kept confidential. 1. Personal Information Name ______________________________________ Social Security No. _____________ First Middle Last Spouse's Name _______________________________ Social Security No. ___________ First Middle Last Home Address ________________________________ ______________ _______ ________ Street City State Zip ____ Own? ____ Rent? How many Years at Current Address: _______________ Previous Address _____________________________________________________________ (If current address is less than 3 years) Your Date of Birth _____________________ Home Phone (____) _________________ Spouse's Date of Birth _________________ Business Phone (____) _____________ Number of Children _____________________ Ages ______________________________ 2. Educational Background High School Graduate? _____ Yes _____ No Year of Graduation ___________ College ______________________________________ ___________________ _________ Name City State Number of Years Attended ________ Did you Graduate? _____ Yes _____ No Area of Concentration __________________________________________________ Other Education ________________________________________________________ (List Type of School, Field of Study and Years Attended) 3. Employment Information Present Employer ______________________________________ Title ______________ Address _________________________________ ___________________ ______ _______ Street City State Zip Date Hired _______________ Salary $______/week $______/month $______/year Nature of Business __________________________________________________________ Brief Description of Responsibilities _______________________________________ _____________________________________________________________________________ Previous Employer _____________________________________ Title ______________ Address _________________________________ ___________________ ______ _______ Street City State Zip Date Hired ________________________ Termination Date ______________________ Nature of Business __________________________________________________________ Brief Description of Responsibilities _______________________________________ _____________________________________________________________________________ Reason for Leaving __________________________________________________________ Spouse's Employer _____________________________________ Title ______________ Address _________________________________ ___________________ ______ _______ Street City State Zip Date Hired _______________ Salary $______/week $______/month $______/year Nature of Business __________________________________________________________ Brief Description of Responsibilities _______________________________________ _____________________________________________________________________________ 4. Additional Information Have you ever owned a business or been self-employed? ______ Yes ______ No If "Yes", what typed of business _________________________________________ Dates of Ownership _______________________________________________________ Have you ever signed an employment agreement or any other type of contract containing a non-compete provision that may prevent you from owning a Great Plains Sauce & Dough Company franchise? ______ Yes ______ No If "Yes", please explain on an attached sheet Have you previously worked in the restaurant or food service industry? ______ Yes ______ No If "Yes", please explain on an attached sheet Do you intend to devote full time to operation of the franchise? ______ Yes ______ No If "No", please explain on an attached sheet Do you plan to own the business with a partner or a finacial backer? ______ Yes ______ No If "Yes", please provide the following information concerning your proposed partner or financial backer: Name _________________________________________________________________ Address ______________________________________________________________ Relationship ___________________________ Years Acquainted ___________ Please note that a separate Person Information Questionnaire must be completed by each partner or financial backer. How much cash do you have available to invest in a Great Plains Sauce & Dough Company franchise? $__________________ How do you propose to finance the initial investment required to open a Great Plains Sauce & Dough company franchise? _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Do you plan to establish a corporation, partnership or any other form of business entity to own and operate your Great Plains Sauce & Dough Company franchise? ______ Yes ______ No If "Yes", please explain on an attached sheet In what geographic area are you interested in establising a Great Plains Sauce & Dough Company franchise? _________________________________________________________________________ Have you, or any business you owned or managed, filed for protection from creditors under any federal or state bankruptcy, insolvency or similar law? ______ Yes ______ No If "Yes", please explain on an attached sheet Have you ever been convicted or plead guilty to any felony or misdemeanor (other than minor traffic violations)? ______ Yes ______ No If "Yes", please explain on an attached sheet Do you have any lawsuits pending against you or any judgements or liens outstanding against you? ______ Yes ______ No If "Yes", please explain on an attached sheet 5. Financial Information Your Assets Your Liabilities ----------- ---------------- Cash in Bank $_______________ Loans & Notes $_______________ (List below) (List below) Life Insurance $_______________ Charge Accounts $_______________ (Cash Value) Marketable Securities Loans Against Life (List Below) $_______________ Insurance $_______________ Residence $_______________ Real Estate Mortgages $_______________ Other Real Estate $_______________ Other Liabilities (List) Profit Sharing $_______________ _____________________ $_______________ (Fully Vested) Other Assets (List) _____________________ $_______________ _________________ $_______________ _____________________ $_______________ TOTAL ASSETS $_______________ TOTAL LIABILITIES $_______________ NET WORTH (Total Assets Less Total Liabilities) $_______________ Schedule of Cash in Banks Bank Name City, State Type of Account Current Balance _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Schedule of Marketable Securities Description Current Market Value _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Schedule of Notes, Loans & Mortgages To Whom Balance Monthly Maturity Secured or Payable Due Payment Date Unsecured _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 6. Statement of Prospective Franchisee. The information contained herein is true and correct to the best of my knowledge as if the date set forth below. I understand that Great Plains Pizza Co. will rely on the information contained herein in evaluating my qualifications to become a franchisee. Dated _____________________________, 19____. ___________________________________________________________ Signature