Fillable Printable Dairy Queen Short Form Application

Dairy Queen Short Form Application

DAIRYQUEENSHORTFORMAPPLICATION

GeneralInformation:

IDQFranchise#

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Location# (provideseparateapplicationsforeachlocation)

LegalnameofFranchise

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EntityType Individual Partnership Corporation LLC RequestedEffectiveDate

ContactName

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YearsinBusiness

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YearsofExperience

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LocationAddress

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MailingAddress(ifdifferent)

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Phone

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Fax

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Email

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FederalTaxIdentificationNumber

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WorkersCompensation:

StateEmployerID#(NJ,IN,MN)

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AnnualPayroll $  ExpMod

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No.ofEmployees

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Under16/Over70

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Isowner’ssalaryincludedinpayroll? Yes No

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StoreInformation

TypeofFranchise DQBrazier Grill&Chill OrangeJulius SoftServe/Cakes/Treats KarmelKorn

Construction WoodFrame Masonry/WoodFrame(JM) Masonry/MetalFrame (MNC) HoursofOperation

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YrBuilt

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DateofRenovation&Type

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No.ofStories

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SqFt

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SeatingAreaSqFt

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SeatingCapacity

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AlarmCentralStation: Burglary Fire Sprinklered Playground Walk‐upOnly Drive‐Thru

Doyou: Ownor Leasethebuilding? Doesyourleaserequireyoutoinsurethebuilding? Yes No

BuildingReplacementValue $ ContentsReplacementValue $  Signson&offPremises $ 

AnnualSales $ %HotFood  %SoftServe/Cakes/SoftDrinks

Isyourstoreaseasonalstore? Yes No Precautionstakenwhileclosed 

Areyouinacoastalstate? Yes No Numberofmilesfromocean 

Hasyourinsurancebeencancelled/non‐renewed? Yes No CurrentBusinessOwnersPremium 

CurrentInsuranceCompany

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No.ofClaimsLast3Years  AmountPaid&TypeofClaim

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CookingAreaInfo

Isthehood&ductsystemequippedwithnon‐combustiblefiltersoragreaseremovalsystem? Yes No

Arefilterscleane ddaily&hood&ductscleanedtwiceyearly? Yes No

NameofAutomaticExtinguisherServingCarrier



Isthereaservicecontractinplace? Yes No LastServiceDate

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DoestheautomaticextinguishingsystemmeettheUL300standard? Yes No

Isthesystem DryChemical WetChemical WaterSpray GaseousorCleanAgent

Isthereanautomaticfuelshutoff? Yes No Howmanyfireextinguishersdoyouhave?

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HowmanyareClass‐K?

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OptionsAvailable

DoyouownanyotherbusinessesinadditiontoDairyQueen? Yes No Describe:

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OptionalCoverages–ChecktoAdd EmployeeBenefitsLiability

Earthquake

IncreasedLiability$2,000,000/$4,000,000

OptionalPolicies–ChecktoAdd UmbrellaLiability

CyberLiability

Flood

BusinessAuto

EmploymentPracticesLiability

BuildersRisk–NewBuildingorRenovation

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Pleasecheckhereifyouareinterestedinreceivinginformationaboutourbankingproducts

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*Pleasenotethatthisisashortformapplication.Additionalinformationmayberequestedinordertoprovideyouwithaquoteforcoverage.

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FaxTo:1.866.925.7116orEmailTo:servicenow@bbandt.com

Questions:Callusat1.888.780.8053