Franchise Questionnaire

First Name:
Last Name:
Address:
City:
State:	Select One Alabama Alaska Arizona Arkansas California Colorado 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 Brunswick New Hampshire New Jersey New Mexico New York North Carolina North Dakota Nova Scotia Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:	(ZIP Code)
Business Phone:	(Phone Number)
Home Phone:	(Phone Number)
Fax:	(Phone Number)
Email:	(E-mail)
Email Verification:	(E-mail)
Restaurant/Business Experience
Territory Interests:
Access to $3MM	Yes No
How did you hear of O'Charley's Franchising?:

— MULTI-UNIT EXCLUSIVE AREA DEVELOPMENT OPPORTUNITIES FOR SUCCESSFUL OPERATORS WITH ACCESS TO $3 MILLION. —
O'Charley's Inc. is a publicly traded company (NASDAQ/NM:CHUX).

This advertisement does not constitute an offer of a franchise and is not directed to residents of any particular state or jurisdiction. No offer or sale of a franchise will be made to the resident of any state except by a Uniform Franchise Offering Circular (UFOC) that, if required, has been registered with appropriate state authorities. If you have any questions, please contact our franchise department toll-free at (877) 772-0001 or e-mail ocfranchise@ocharleys.com.