Lions Creek Partnership Application Form

Please complete this form to apply for a partnership with Lions Creek. The information you provide will help us better understand your qualifications and suitability for a partnership opportunity. Once you have submitted your application, our team will review it and contact you to discuss the next steps.

Please upload the following files as a part of your application submission:

• Your Resume
• A Business Plan - if applying for store or multi-store model
• Other applicable documents including letters of reference, certifications, etc.

Personal Information:

1. Name:
2. Date of Birth:
3. Address:
4. Country:
5. State / Province:[uacf7_state* State autocomplete:true]
6. City:[uacf7_city* CityofResidence autocomplete:true]
7. Postal / Zip:[uacf7_zip* ZIP autocomplete:true]
8. Phone Number (with area code):
9. Email Adress:
10. Preferred Engagement Model:DeliRetailDedicated StoreMulti-Store
11. Do you have a preferred location?YesNo
>Preferred Country for Partnership:
Preferred City for Partnership:[uacf7_city PreferredPartnershipCity autocomplete:true]
Preferred Address for Partnership (if known):
12. Do you have prior experience in the food or retail industry? YesNo
Please provide a brief description of your experience:
13. Please provide a brief overview of your financial capacity and investment plan for the proposed partnership:
14. Are you currently involved in any other business ventures or partnerships? YesNo
Please provide an overview of your other business ventures:

I, , hereby declare that the information provided in this application is true and complete to the best of my knowledge. I understand that any false or misleading information may result in the rejection of my application or termination of any partnership agreement entered into with Lions Creek. Signed on the day of , .