Personal Details
* First Name:
* Last Name:
* Phone:
* Address1:
* Zip:
* City:
* State:
* List all your skills revelant to restaurant business:
If any other managerial experience, please explain:
Have you ever visited a Cluck-U Chicken store
If yes, which location:
Date of your last visit:
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Investment Details
* In the space provided, briefly state why you have selected food service and why you believe Cluck-U Chicken may be the right Franchise for you:
* Amount of cash available for investment:
* Do you have a source of financing?
* What amount of financing do you believe you could qualify for?
Location Preference:
* Do you intend to run this business yourself?

I hereby authorize Cluck-U, Corp. and its agent(s) to thoroughly investigate my background, employment record, criminal record, credit history, and other matters related to my qualifications for a Cluck-U Chicken Bar and Grill Franchise unit. I authorize any person, including my current employer (if applicable), previous employers, credit reporting agencies, or other reporting persons or organizations contacted by Cluck-U, Corp. to provide any relevant information regarding this application or my history.

I waive my rights under the Privacy Act, 5 U.S.C. 552a and similar state laws.
By submitting responses to this questionnaire, I agree that Cluck-U, Corp. many rely on my responses.

I understand that misrepresentation or omission of facts may result in rejection of my application. By typing my name and submitting this questionnaire, I agree to all the preceding terms.


Currently we are not offering Bar and Grill, however we might offer it in future. you are still interested,then you may reach out to us. We reserve the right to approve it under certain circumstances and condition.


* Name:
* Date
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