Thank you for your interest in Cleats Club Seat Grille.  Please take a few moments to fill out the information in the form below. 

It is understood and agreed that my submission of this application does not create an obligation for CLEATS RESTAURANTS, LLC. to award me a license.

It is understood that more detailed information, including finacial statements, bank statements may be requested at a later date before CLEATS RESTAURANTS, LLC. can award me a license.

	Email Address:*
	How were you refered to us?:*		Online Plain Dealer Friend
	Principal Applicant's Full Name:*
	Social Security Number:
	Residence Address:*
	Address (continued):
	City:*
	State:*
	Zip Code:*
	# Years at Present Address:*
	Do you rent or own:*		Rent    Own
	Date of Birth (mm-dd-yyyy):*
	Home Phone #:*
	Mobile #:*
	Current Employer:
	Annual Salary:*
	General Duties :*
	Spouse's Full Name:
	Best Time To Contact You:*
	FINANCIAL INFORMATION
	Annual Income:*
	Spouse's Annual Income:
	Other Income:
	Interest and Dividends:
	Total Annual Income:*
	Do you own your own business?:*		Yes    No
	Have you ever filed for personal bankruptcy?:*		Yes    No
	Have you ever filed for business bankruptcy?:*		Yes    No
	Have you ever had anything repossessed??:*		Yes    No
	Total Assets:*		0-$50K $50K-$150K $150K-$250K $250K-$350K $350K-$500K $500K-$700K $700K-$900K $900K-$1.1M $1.1M+
	Less Total Liabilities:*
	Total Net Worth:*
	LEGAL INFORMATION
	Will you have any other partners?:*		Yes    No
	If "YES" please list their involvement::
	Have you owned a business before?:*		Yes    No
	If "YES" please explain::
	Have you ever been convited of a felony?:*		Yes    No
	If "YES" please explain::
	Do you have any felony charges pending?:*		Yes    No
	Location Information
	Do you have a location in mind?:*		Yes    No
	If "YES" list city, state, and zip code:
	City:
	State:
	Zip Code:
	How much start-up capital will you have?:*
Fields with * are required.