This is for informative purposes only. The submission of this Questionnaire does not obligate you or Friendly's Restaurants Franchise, LLC in any way or manner.

	*Required Information
*First Name:		*Last Name:
*Address:		*City:
Address:		*State/Zip:	Choose a state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming /
*Phone:	( ) -	Cell Phone:	( ) -
Fax:	( ) -
*E-mail:		*Verify E-mail:
	*Restaurant/Business Experience:
	*Your Estimated Net Worth: select one less than $1,500,000 $1,500,000 - $3,000,000 $3,000,000 - $5,000,000 $5,000,000 - $10,000,000 greater than $10,000,000
	*Your Estimated Liquidity: select one less than $650,000 $650,000 - $1,000,000 $1,000,000 - $2,000,000 greater than $2,000,000
	*Territory Interest:
	How did you Hear about Friendly's Franchise? select one Friendly's Website Friendly's Patron - In Restaurant Trade Publication Trade Show Internet Referral Other
	Please enter any comments or questions below.