Personal History (all questions are required) Name Date of Birth Address City State Zip Code Home Phone Business Phone E-mail Address US Citizen Yes No Do you plan to personally operate the business? Yes No If Yes, how are you qualified to operate a restaurant? If no, what will your role be? Current Occupation How Long? Why have you chosen a J.R. Crickets? How did you find out about J.R. Crickets Enterprises Inc., business opportunities? Site Selection 1. Describe your ideal location: 2. State: 3. Country: 4. City or Town: 5. Why have you chosen this area? 6. Do you have a specific location in mind? If so, please give the address:

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