Name:	*
Company:	*
Address:	*
City:	*
State:	*
Zip:	*
Phone Number:	*
E-mail:	*
Proposed site: street intersection	*
City:	*
State:	*
Type of Site:	-- select one -- Raw land Endcap with drive-thru In-line
Size:	*
Frontage:	*
Depth: in feet
Total Square Footage: in feet	*
If site is larger than 1/2 an acre, will the owner divide this Lot?	-- select one -- Yes no *
Any existing Wienerschnitzel restaurants within 3 miles?	-- select one -- Yes no *
Comments: