Apply for a Teriyaki Franchise

Disclaimer and Confidentiality Agreement

I understand that the granting of a franchise is at the sole discretion of the Franchisor (SMK Franchising Inc.).

I understand that any information I receive from the Franchisor or from any employee, agent of franchisee of the Franchisor is highly confidential (“Confidential Information”), has been developed with a great deal of effort and expense to the Franchisor, and is being made available to me solely because of this Application. I agree that I shall treat and maintain all Confidential Information as confidential, and I shall not, at any time, without the express written consent of the board of directors of the Franchisor, disclose, publish, or divulge any Confidential Information to any person, firm, corporation or other entity, or use any Confidential Information, directly or indirectly, for my own benefit or the benefit of any person, firm, corporation or other entity, other than for the benefit of the Franchisor.

I authorize the procurement of an investigative consumer report, a general background search and an investigation in accordance with anti-terrorism legislation, such as the USA Patriot Act and Executive Order 13224 enacted by the US Government (collectively referred to as “Investigations”). I understand that these Investigations may reveal information about my background, character, general reputation, mode of living, association with other individuals or entities, creditworthiness, litigation history and job performance. I understand that, upon written request, within a reasonable period of time, I am entitled to additional information concerning the nature and scope of these Investigations. I hereby release a representative of the Franchisor, a credit bureau, security consultant or other investigative service provider selected by the Franchisor, its officers, agents, employees, and/or servants from any liability arising from the preparation of these Investigations.

This authorization for release of information includes but is not limited to matters of opinion relating to my character, ability, reputation, association with others and past performance. I authorize all persons, schools, companies, corporations, credit bureaus, law enforcement agencies or other investigative service providers to release such information without restriction or qualification to a representative of the Franchisor, a credit bureau, security consultant or other investigative service provider selected by the Franchisor and any of its officers, agents, employees and/or servants. I voluntarily waive all recourse and release them from liability for complying with this authorization. This authorization/release shall apply to this as well as any future request for these Investigations by the above named individuals or entities. I authorize that a photocopy or facsimile of this release be considered as valid as the original.

Everything that I have stated in this application is true and I understand that the information provided by me will be relied upon by the Franchisor. In accordance with anti-terrorist legislation, I understand that I will not be approved to purchase a franchise if I have ever been a suspected terrorist or associated directly or indirectly with terrorist activities. I read, understand, and agree to all of the above.

Contact Information (Section 1)
Mandatory field First Name:**
Middle Name:
Mandatory field Last Name:**
Mandatory field Address:**
Mandatory field City:**
Mandatory field State / Province:**
Mandatory field Zip Code:**
Mandatory field Date of Birth:**
E-mail Address:
Home Phone:
Cell Phone:
Work Phone:
Mandatory field Are You Married?:**	Yes No
If you are married, please provide your spouse's name:
Will you have other owners/partners?:	Yes No Not Sure
If yes to the question above, please provide names of partner(s):
Employment Information (Section 2)
Employment Status:	Self Employed Employed
If you are employed, please complete the information below.
Name of Company:
Position at Company:
Financial Information (Section 3)
Mandatory field A. Total Liquid Assets available (e.g. cash, stocks, bonds, mutual funds) ($125,000 Required):**
Mandatory field B. Total Tangible Assets (e.g. house, car, business, etc.):**
Mandatory field C. Total Assets (Add A to B):**
Mandatory field D. Total Liabilities:**
Mandatory field E. Total Net Worth (Total assets minus total liabilities - Subtract D from C):**
($225,000 Net worth required for each new unit)
Would this business be your sole income source?:	Yes No
Mandatory field How much money are you prepared to invest in a Sarku Japan Franchise?:**
Mandatory field Source of investment funds:**
How much would you need to borrow?:
Where would you borrow the needed funds and on what terms?:
Personal Information (Section 4)
Mandatory field Have you ever filed for bankruptcy?:**	Yes No
If yes, identify discharge date:
Mandatory field Have you ever been convicted of a felony?:**	Yes No
Mandatory field Have you ever been associated directly or indirectly with terrorist activities?:**	Yes No
Mandatory field Are you or anyone in your immediate family a partner, owner (partial or otherwise), or employee of a restaurant or deli?:**	Yes No
If yes, list name of business and family relationship:
Mandatory field Are you or anyone in your immediate family currently under any form of non-compete that limits your right to operate any business?**	Yes No
If yes, list name of business and family relationship:
Mandatory field Are you legally entitled to work in the United States?:**	Yes No
Mandatory field Would you personally operate your Sarku Japan Restaurant?:**	Yes No
If no, how would you manage it?:
Mandatory field Location Preference:**
Mandatory field Number of Units:**
Mandatory field If qualified, when will you invest in a franchise?:**
Mandatory field I agree that I must pass the interview:**	Agree
Disclaimer and Confidentiality Agreement I understand that the granting of a franchise is at the sole discretion of the Franchisor (SMK Franchising Inc.). I understand that any information I receive from the Franchisor or from any employee, agent of franchisee of the Franchisor is highly confidential (“Confidential Information”), has been developed with a great deal of effort and expense to the Franchisor, and is being made available to me solely because of this Application. I agree that I shall treat and maintain all Confidential Information as confidential, and I shall not, at any time, without the express written consent of the board of directors of the Franchisor, disclose, publish, or divulge any Confidential Information to any person, firm, corporation or other entity, or use any Confidential Information, directly or indirectly, for my own benefit or the benefit of any person, firm, corporation or other entity, other than for the benefit of the Franchisor. I authorize the procurement of an investigative consumer report, a general background search and an investigation in accordance with anti-terrorism legislation, such as the USA Patriot Act and Executive Order 13224 enacted by the US Government (collectively referred to as “Investigations”). I understand that these Investigations may reveal information about my background, character, general reputation, mode of living, association with other individuals or entities, creditworthiness, litigation history and job performance. I understand that, upon written request, within a reasonable period of time, I am entitled to additional information concerning the nature and scope of these Investigations. I hereby release a representative of the Franchisor, a credit bureau, security consultant or other investigative service provider selected by the Franchisor, its officers, agents, employees, and/or servants from any liability arising from the preparation of these Investigations. This authorization for release of information includes but is not limited to matters of opinion relating to my character, ability, reputation, association with others and past performance. I authorize all persons, schools, companies, corporations, credit bureaus, law enforcement agencies or other investigative service providers to release such information without restriction or qualification to a representative of the Franchisor, a credit bureau, security consultant or other investigative service provider selected by the Franchisor and any of its officers, agents, employees and/or servants. I voluntarily waive all recourse and release them from liability for complying with this authorization. This authorization/release shall apply to this as well as any future request for these Investigations by the above named individuals or entities. I authorize that a photocopy or facsimile of this release be considered as valid as the original. Everything that I have stated in this application is true and I understand that the information provided by me will be relied upon by the Franchisor. In accordance with anti-terrorist legislation, I understand that I will not be approved to purchase a franchise if I have ever been a suspected terrorist or associated directly or indirectly with terrorist activities. I read, understand, and agree to all of the above.

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Contact Information (Section 1)

Employment Information (Section 2)

Financial Information (Section 3)

Personal Information (Section 4)

Disclaimer and Confidentiality Agreement