Outback Steakhouse

This request is for general information to evaluate your preliminary qualifications to be awarded a franchise. This is not an application. Should you preliminarily qualify and a mutual interest develops, we will request more detailed information. The submission of this form does not obligate Outback Steakhouse or you in any way or manner.

Name
Address
City
Country
Country Code
Years at this address
Business Phone
Home Phone
Email Address
Citizenship
Permanent Residence Rights
Immigration Status
Describe your present or past restaurant experience
Describe your current business and position
If you are inquiring on behalf of your company, please provide a description of your company
Do you plan to have equity partners?	YesNo
If you have identified those partners, please include a brief background description of each, as well as your own
What percentage of equity will each of the partners have?
Please describe your company's operating and development experience (Specifically, have you successfully developed ground-up projects?)

Financial	Qualifications typically require a net worth or combined net worth of $3,000,000 including approximately $1,000,000 liquidity. Please include approximate personal net worth and cash available for you and your partner(s).
Yourself
Approximate Personal Net Worth	$
Approximate Personal Cash Available	$
Approximate Business Net Worth	$
Approximate Business Cash Available	$
Partner 1
Approximate Personal Net Worth	$
Approximate Personal Cash Available	$
Approximate Business Net Worth	$
Approximate Business Cash Available	$
Partner 2
Approximate Personal Net Worth	$
Approximate Personal Cash Available	$
Approximate Business Net Worth	$
Approximate Business Cash Available	$

Please describe your preliminary plans for financing this venture
Country you are interested in
Number of stores you are prepared to develop over a three to five year period

The undersigned certifies that the information furnished on this form is true, correct and complete. The undersigned also authorizes Outback Steakhouse to make additional credit/character check which it deems necessary. Typing your name below constitutes a signature.
Your Name
Date