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1
TIM HORTONS®
FRANCHISE APPLICATION
Submitted By _________________________________
A Resident Of ___________________________________
Your submission of the completed Personal Profile begins the Franchise Application process with Tim Hortons
USA, Inc. (“TH”). TH will use the information you submit and other information in making assessments about your
franchise application. A separate Personal Profile must be submitted for each individual you propose to be involved
in your business as (i) an operator or (ii) an equity owner with at least ten percent (10%) ownership interest in the
entity proposed to be the franchisee.
Submitting this Personal Profile does not obligate you to enter into any agreement relating to a restaurant franchise
with TH and does not obligate TH to grant a franchise to you. Neither you nor TH will have any contractual
obligation concerning a restaurant franchise unless and until a formal written agreement is executed by you and
by an authorized TH representative.
Provide complete and accurate information as requested. Attach Additional Information Sheets as necessary to
provide a complete response. Please type or print legibly.
Please send application to: emason@rbi.com.
2
1. CONTACT INFORMATION
Name
Last First Middle Nickname
Address:
Including Apartment Number, if applicable
City State/Province Zip/Postal Code Country
Residence Telephone (___)
Mobile Telephone (___)
E-mail Address
Previous Address:
Including Apartment Number, if applicable
City State/Province Zip/Postal Code Country
List any other countries you have lived in after the age of twenty-one (21), other than indicated above, and how
long you have lived in that country:_________________________________________________________
2. PERSONAL INFORMATION
2.1 General
Social Security/Insurance Number Driver’s License Number
Date of Birth Marital Status
I am a citizen of I have permanent residence rights in
Number of Dependents Age of Dependents
Home: Own Rent How long? Gender: Female Male Other
2.2 My immigration status, if applicable, is
(Attach supporting documentation.)
2.3 Military Service From to
Branch of Service Rate or Rank
Type of Discharge or Current Status
3. BACKGROUND AND RELATIONSHIPS
3.1 Have you ever been convicted of a felony or misdemeanor or are such
charges pending, being appealed, or are you under indictment? (Do not
include minor traffic violations)
Yes
No
3.2 Have you ever sought protection under bankruptcy or other similar laws? Yes
No
3.3 Have you been an owner or executive of a company in bankruptcy (other
than a passive owner of publicly traded shares)?
Yes
No
3
3.4 Have you ever been an officer, director, employee or franchisee of
Restaurant Brands International (“RBI”), the Burger King® brand, the Tim
Hortons® brand, or the Popeyes® brand?
Yes No
3.5 Are you related to any officer, director, employee or franchisee of RBI,
the Burger King® brand, the Tim Hortons® brand, or the Popeyes®
brand?
Yes
No
3.6 Do you or your employer have a business relationship (including as a
supplier of goods or services) to RBI, the Burger King® brand, the Tim
Hortons® brand, or the Popeyes® brand?
Yes
No
3.7 Are you now, or have you ever been a franchisee in any system,
including but not limited to a competitor of the Burger King® brand? If
yes, identify system, your location, and time period.
Yes
No
3.8 Have you ever been an investor in or operator of any quick service
restaurant, including but not limited to a competitor of the Tim Hortons®
brand?
Yes
No
3.9 Are you involved in any pending litigation? Yes
No
3.10 Have you ever had a business failure? Yes
No
If you answered “yes” to any of the above questions, please provide details on an Additional Information Sheet.
4. EXPERIENCE
4.1 Present Occupation
From: to
Company: Position/Title:
Address: Telephone: (____)
Annual Salary: Supervisor:
Describe the company’s business, duties and responsibilities, and number of employees you supervise:
May we contact your present employer? Yes No
May we contact you at your business? Yes
No
4.2 Previous Experience (Use Additional Information Sheets as needed.)
From: to
Company: Position:
Address: Telephone: (____)
Supervisor:
Describe duties, responsibilities and number of employees supervised:
4
5. EDUCATION
Name and location of schools, years completed and degrees earned.
6. BUSINESS INTEREST
6.1 Will any person other than you (including your spouse) contribute any
funds or resources (including real estate) to the franchise opportunity you
are seeking? (If yes, provide details on Additional Information Sheet.)
Yes
No
6.2 I am interested in buying an existing Restaurant. Yes
No
6.3 I have identified one or more specific Restaurants that I am interested in
buying. (If yes, provide details on Additional Information Sheet.)
Yes
No
6.4 I am interested in opening a new Restaurant. Yes
No
6.5 I have identified one or more specific locations at which I am interested in
operating a Restaurant.
Yes
No
6.6 I have the resources and interest to own multiple Restaurants. Yes
No
6.7 The following are my geographic preferences:
1
st
________________ 2
nd
________________ 3
rd
________________
6.8 Are you willing to relocate? Yes
No
6.9 Do you intend to spend full time operating your restaurant business if you
become a franchisee?
Yes
No
6.10 Do you currently have an ownership interest in any business venture,
including commercial real estate? If yes, provide details on separate
sheet.
Yes
No
7. FINANCIAL RESOURCES AND ORGANIZATION
7.1 How much cash can you personally invest in a restaurant business? $
7.2 What is the source of those funds?
7.3 What is your approximate net worth? $
7.4 What cash or liquid funds do you currently have? $
7.5 If you will not be the only owner in the business, list all owners and investors below and describe their
participation.
Expected Approximate
Name of Owner Percent Ownership Cash Investment Net Worth
1. _______________________ __________________ ______________ __________________
2. _______________________ __________________ ______________ __________________
3. _______________________ __________________ ______________ __________________
5
4. _______________________ __________________ ______________ __________________
7.6 Which owner will function as the “chief executive” in your group?
7.7 Who will be full time in charge of restaurant operations?
7.8 Which owner/s plan to devote full time to the restaurant business?
7.9 Will any person or entity other than the partners be entitled to receive,
directly or indirectly, part of the profits from the operation of the restaurant?
If so, provide details on Additional Information Sheet.
Yes No
7.10 If you are approved for a restaurant franchise, will any partner be involved
in any business activity other than the restaurant business? (If so, provide
details on Additional Information Sheet.)
Yes
No
7.11 Will the Operating Partner receive income from any source other than the
restaurant? (If so, provide details on Additional Information Sheet.)
Yes
No
8. REFERENCES/OTHER
Please provide contact information for at least three references who are familiar with your character and
business accomplishments. References from family members will not be considered.
Name Relationship Telephone E-mail
Attachments: Resume _______ pages attached
Personal Financial Statement _______ pages attached
Additional Information (for Application Questions) _______ pages attached
Tax Returns (last 2 years) _______ pages attached
Proof of Bank Financing _______ pages attached
Asset Verification documents _______ pages attached
Proof of Salary _______ pages attached
Broker Statement of Account for Investments _______ pages attached
Current Loan Statements for Outstanding Loans _______ pages attached
Real Estate Valuation from Registered Agent _______ pages attached
Other (Discretionary) _______ pages attached
6
Applicant’s Statement and Verification:
I am submitting this Personal Profile as part of my application for a TH restaurant franchise. I confirm and represent
that the personal and financial information I am submitting is true and complete as of the date below. I understand
that TH and its affiliates consider this information important and may rely on the information I submit in making
decisions about whether to continue processing my franchise application, to allow me access to training programs
and confidential materials, and to enter into an agreement with me. If there is any material change in the
information submitted here or later submitted by me during the franchise application process with TH, I will promptly
notify TH in writing of the change or formally withdraw my application so that TH does not rely on information that
to my knowledge has become incorrect or incomplete in any material way.
I authorize TH to check my character, my background, my motor vehicle record, and my financial and credit history.
I expressly authorize any past or present employer, any law enforcement agency, and any person who has
knowledge of my character, experience and activities (including by way of example, education and work
experience), or financial or credit history to release this information to TH. I understand that one or more credit
reporting agencies may make credit histories available to TH upon which it may rely, and that financial institutions
with which I have relationships may also supply information about their relationship with me. If any person
authorized by me provides true and accurate information to TH about me, then to the extent that person is or would
be liable to me in any way as a result of furnishing such information, I release such person from such liability. I
authorize TH to release to prospective financing sources such financial and other information concerning me in its
files as may be requested.
In addition, I authorize the procurement of an investigative background search in accordance with anti-terrorism
legislation, such as the USA Patriot Act and Section 1 of U.S. Executive Order 13224, issued September 23, 2001,
if applicable. I also certify that neither I nor any of my funding sources, is or has ever been a terrorist or suspected
terrorist, or a person or entity described in the aforementioned legislation. I understand that my application will not
be approved if I have ever been a suspected terrorist or associated in any way with terrorist activities.
By submitting this application, I consent to TH and its agents or designees collecting, using, disclosing, and
retaining my personal information as is reasonably required in the course of TH’s evaluation of my application,
including to assess my eligibility, process my application, and respond to me. For further information concerning
how TH collects, uses, discloses, and retains personal information, please refer to TH’s privacy policy at
www.timhortons/us.com or send an email to privacy@rbi.com and ask for a copy.
I acknowledge and consent to the collection of additional information and investigation with respect to the
information provided above, and with respect to my financial status, litigation history, criminal record history,
educational credentials, employment history, driving record, reputation, and mode of living. I also hereby consent
to TH’s collecting, using, disclosing, and retaining such information and conducting further investigations with
respect to such information. I consent to the updating of this information from time to time, when necessary.
__________________________________ _________________________________
Print Name Date
__________________________________
Signature
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7
TH is an equal opportunity franchisor committed to expanding franchise ownership
opportunities for members of minority groups. You are not required to identify your ethnic
group. The following is solely intended to assist TH in measuring its progress against those
commitments.
O Asian Pacific O Hispanic O African American
O Native American O Caucasian O Indian/Pakistan/Middle Eastern
O Two or more races
1
Additional Information Sheet (may add
more sheets as necessary)
Page
Applicant Name
Date
Question Number(s)
2
PERSONAL FINANCIAL STATEMENT
As of _______________:
ASSETS
LIQUID ASSETS
(A) Cash (Unrestricted) (see attached Schedule No. 1)
$
(B) Publicly Traded Stocks, Bonds and Government Securities
(see attached Schedule No. 2)
$
(C) TOTAL LIQUID ASSETS (A & B)
$
NON-LIQUID ASSETS
(D) Real Estate (See attached Schedule No. 3)
$
(E) Market Based Equity in Restaurant Business (See attached Schedule No.
4)
$
(F) Personal Property (Automobiles, Jewelry, Household Other) (see
attached Schedule 5)
$
(G) Other Assets, as applicable, (IRA’s, 401K’s, RSP’s, Pension Plans, Cash
Value of Life Insurance, Notes Receivables, Value on Non- Restaurant
business) (See attached Schedule No. 6)
$
(H) TOTAL NON-LIQUID ASSETS (D + E + F + G)
$
(I) TOTAL ASSETS (C & H)
$
LIABILITIES
(J) Notes Payable – Unsecured (See attached Schedule No. 7)
$
(K) Notes Payable – Secured (See attached Schedule No. 7) $
(L) Mortgages Payable – Real Estate (See attached Schedule No. 3) $
(M) All other Liabilities (See attached Schedule No. 7) $
(N) TOTAL LIABILITIES (J + K + L + M)
$
NET WORTH (I & N)
$
The undersigned certifies that the information furnished in this personal financial statement is true,
correct, and complete.
Name (Type or Print) Name (Type or Print)
Signature Signature
Date Date
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3
Personal Financial Statement
Supplementary Schedules
No. 1 – Cash (Unrestricted)
Name of Institution/Description Type of Account Date of Statement Balance
Total
Ties to (A)
No. 2 – Publicly Trade Stocks, Bonds and Government Securities
Name/Description Type # of Shares Estimated Value
Total
Ties to (B)
No. 3 – Real Estate
(Attach a separate list if necessary)
Type of Property
Street Address
City, State
Estimated
Market Value
Mortgage
Balance
Equity in
Real Estate
Total
Ties to (D) Ties to (L)
No. 4 – Market Based Equity in Restaurant Business (Include ONLY your existing financial stake in Restaurant Business. Do NOT
include projected equity in a contemplated transaction.)
(A) (B) (C) (D) (E) (F)
EBITDA EBITDA Multiple
Market Value of
Business
(A) X (B) Liabilities
Market Based Value
of Business
(C) – (D)
Percent
Ownership
Market Based Equity
in Restaurant
Business
(E) x (F)
Ties to (E)
4
No. 5 Personal Property
(include Automobiles, Jewelry, Household, Other)
Asset Description Estimate Value
Total
Ties to (F)
No. 6 Other Assets
(include IRA’s, 401K’s, RSP’S, pension plans, notes receivable, cash value of insurance, etc.)
Asset Description Estimate Value
Total
Ties to (G)
Non- Restaurant Business:
(A) (B) (C) (D) (E) (F)
EBITDA EBITDA Multiple
Market Value of
Business
(A) X (B) Liabilities
Market Based
Value of
Business
(C) – (D)
Percent
Ownership
Market Based
Equity in Non-
Restaurant
Business
(E) x (F)
Ties to (G)
No. 7 – Notes, Loans, Accounts Payable and Other Liabilities
(Attach a separate list if necessary)
Name of Lender
Description/ Type
Of Debt
Collateral
(if any)
Monthly
Payment
Balance
Total Unsecured Ties to (J)
Total Secured Ties to (K&L)
Total Other Liabilities Ties to (M)
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Completed 12 December 2020

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