Form

Thank you for your interest in Melting Pot! We are excited that you are considering our company as your franchise business opportunity!

Complete the information request form below and we’ll be in touch to review your qualifications and answer any questions you may have about franchise ownership.

Please be advised that Melting Pot reserves the right to request additional documentation to verify and clarify any and all financial information provided on this application that are not available during the background check process. This may include, but is not limited to, bank statements, tax returns, or other relevant financial records. Our aim is to ensure the accuracy and completeness of the information submitted.

By submitting this application, you acknowledge and agree to provide any further documentation as requested by Melting Pot for the purpose of financial verification.

Lead Qualification Details

Fields marked with * are mandatory.

Request for Consideration - Financials

-Melting Pot requires a franchising fee of $45,000-Minimum cash investment is $400,000 USD with a total combined Net Worth of $1M USD-Range of total investment is a low estimate of $1,339,023 to a high estimate of $1,587,201 or more (depending on your site, build-out costs, credibility, and other factors)

I am aware of these financial obligations and figures for consideration*

Request for Consideration - Training

-Training is a minimum seven weeks for new owners and management teams. Consistent with the on-the-job training with a certified Melting Pot team and in collaboration with the Restaurant Support Center. The initial Franchise Fee includes training for up to four people.-Active ownership or dual ownership/operator roles are required for all applicants.-Initial term of the franchise agreement is 10 years, with a renewal of 5 year successor agreement.

I am aware of these operator obligations and figures for consideration*

I. PERSONAL INFORMATION

First Name*

Last Name*

Present Street Address

City*

State / Province*

Zip / Postal Code*

Country

Work Phone Number

EMPLOYER

Email*

Previous Address

State / Province

City

Country

Zip / Postal Code

Home Ownership

Own

Renting

How long at this address? (Yrs) :

US Citizen

Yes

If No please provide copies of your Alien Registration Card (front back) :

LANGUAGES SPOKEN FLUENTLY

MILITARY SERVICE

Yes

Military Service From

Month/Day/Year

Military Service To

Month/Day/Year

TYPE OF DISCHARGE OR CURRENT STATUS

EDUCATION LEVEL:

High School/Year

Bachelor's/Year

Graduate/Year

Post Graduate/Year

For each question below, "you" means you, your affiliates or any corporation in which you have been a principal, officer, director or trustee, any partnership in which you have been a partner, or any other business entity in which you have held a management position or ownership interest equal to 5% of more.

HAVE YOU EVER BEEN ARRESTED CHARGED CONVICTED OR PLEADED NOLO CONTENDRE FOR ANY CRIMINAL OFFENSE (MISDEMEANOR OR FELONY) OTHER THAN A MINOR MOTOR VEHICLE VIOLATION?

Yes

If Yes please provide details :

HAVE YOU EVER FILED OR HAD FILED AGAINST INVOLUNTARILY FOR PERSONAL OR BUSINESS BANKRUPTCY PROTECTION INSOLVENCY PROCEEDINGS OR COMPROMISE WITH CREDITORS?

Yes

If Yes please provide details :

HAVE YOU BEEN INVOLVED IN ANY LAWSUITS OR POTENTIAL LITIGATION?

Yes

If Yes please provide details :

HAVE YOU EVER BEEN A DEFENDANT IN CIVIL LITIGATION ALLEGING FRAUD MISREPRESENTATION UNFAIR TRADE PRACTICES RICO DECEIT OR SIMILAR CLAIMS :

Yes

If Yes please provide the nature of the allegation and its disposition :

HAVE YOU EVEN BEEN KNOWN UNDER ANY OTHER NAME(S) :

Yes

If Yes please provide detail :

II. PROFESSIONAL EXPERIENCE

Company 1

Address 1

City 1

State 1

Zip Code 1

TYPE OF BUSINESS 1

POSITION 1

DATES OF EMPLOYMENT 1

Month/Day/Year

PHONE 1

SUPERVISOR 1

Describe Responsibilities 1

Number of Employees 1

COMPANY 2

Address 2

City 2

State 2

Zip Code 2

TYPE OF BUSINESS 2

POSITION 2

DATES OF EMPLOYMENT 2

Month/Day/Year

PHONE 2

SUPERVISOR 2

Describe Responsibilities 2

Number of Employees 2

COMPANY 3

Address 3

City 3

State 3

Zip Code 3

TYPE OF BUSINESS 3

POSITION 3

DATES OF EMPLOYMENT 3

Month/Day/Year

PHONE 3

SUPERVISOR 3

Describe Responsibilities 3

Number of Employees 3

III. BUSINESS EXPERIENCE

DO YOU PRESENTLY HAVE ANY COMMITMENTS OR ARRANGEMENTS WHICH MAY INTERFERE IN YOUR BECOMING A FRANCHISEE OF Melting Pot™?

Yes

ARE YOU CURRENTLY A FRANCHISEE OF ANOTHER CONCEPT?

Yes

HAVE YOU EVER HAD A FRANCHISE TERMINATED OR NON-RENEWED?

Yes

IV. PARTNERS

WILL YOU HAVE BUSINESS PARTNER(S)?

Yes

Name of Partners

Principal Operator

TO WHAT EXTENT WILL YOU BE INVOLVED IN DAILY OPERATIONS?

WHAT PERCENT EQUITY OF THIS CORPORATION/LLC WILL YOU POSSESS?

WHAT PERCENT EQUITY OF THIS CORPORATION/LLC WILL BE AVAILABLE TO AN OPERATING PARTNER?

HOW WILL THE EQUITY PERCENTAGE TO THE PRINCIPAL OPERATOR BE ACHIEVED?

WILL THE MELTING POT FRANCHISE BE CONSIDERED YOUR PRIMARY SOURCE OF INCOME?

Yes

V. GEOGRAPHIC AREA OF INTEREST

First Choice

Second Choice

Third Choice

NUMBER OF UNITS YOU WOULD LIKE TO DEVELOP

OVER WHAT TIME PERIOD

I understand that if I wish to be considered for a Melting Pot's International, LLC ("Melting Pot") franchise, I must complete all the data requested on this application, sign where indicated and return the completed application with all required documentation to Melting Pot.This application in no way obligates you or Melting Pot in any manner. All information contained in and provided pursuant to this application will be kept confidential by Melting Pot. This form is not to be construed as an offer of a franchise, a commitment or a binding agreement on either party. This information has been provided for the specific purpose of obtaining a Melting Pot franchise and is for Melting Pot use in rendering a decision.I submit the foregoing information as my complete and true personal and financial condition, operational qualifications and background as of the date shown below. In accordance with the Privacy Act, Freedom of Information Act, the Fair Credit Reporting Act, and any similar federal, state, local statutory or common laws or regulations, I expressly authorize all persons,companies, entities, associations, consumer reporting agencies, firms, bureaus, and court systems to release to Melting Pot, or its representatives, agents or designees, any and all information that my be requested (including, but not limited to, information concerning my education, employment history, financial transactions, civil records, criminal conviction records, legal proceedings or judgement or any other records or reports) and for Melting Pot to use such information for the purpose of conducting any background checks in connection with this Franchise Development Application. I hereby release Melting Pot and its representatives, agents or designee from any and all claims, liabilities, losses or damages relating to this Franchise Development Application or relating to any background checks conducted in connection with my application.I understand that Melting Pot is relying upon all the information contained in this Franchise Development Application and any supporting documentation and information I provide as material factors in consideration of my application to become a franchisee, and I therefore agree to promptly notify Melting Pot of any material change in any of the documentation and information provided herein or provided in connection with my Franchise Development Application.

APPLICANT'S SIGNATURE

DATE 1

SPOUSE'S SIGNATURE

DATE 2

(NOTE: Each partner must submit a separate Franchise Development Application)