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First Name *  
Last Name *  
Email *
Phone *  
Company Name
Address 1 *  
Address 2
City *  
State *  
Zip *
Mobile Phone
Do you, your partners and business entities have restaurant experience? *  
 
Do you plan to operate the restaurant yourself? *  
 
Do you, your partners and business entities have a Net Worth of at least $1M *  
 
Do you, your partners and business entities have Liquid Assets of at least $350,000 *  
Do you have a location preference?
City State
City State
City State
How did you learn about Country Kitchen?
 
Comments
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