fab'rik Atlanta

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Thank you for your interest in the fab'rik franchise. This is an exciting opportunity for us all. The purpose of this request for consideration is for general information in evaluating your qualifications to be considered for a fab'rik franchise. This is not an application. Should you appear to qualify and a mutual interest develops, we will request additional information and conversations will continue. * indicates required field.

1. Applicant's Data

name *
email *	phone *
address *
city *
state *	zip *
date of birth	martial status

2. Business Experience
(Please list company name, type of business, position held, dates position held, and your most significant accomplishments)

present/most recent position: *

previous position: *

have you ever owned a business? If yes, what type? *

other business affiliations: (officer, director, partner, etc) *

3. Preliminary Financial Disclosure
(Please list amounts in US Dollars, excluding home, personal automobile, personal property)

assets $	unencumbered liquid assets available $
liability $	personal property $
net worth $	other real estate $

4. Business and Management Goals

location preference 1:

location preference 2:

desired opening date of first fab'rik store:

would you devote full time to this business venture?

Yes

would your spouse be active in the franchise?

Yes

would you have any business partners?

Yes

why do you want to open a fab'rik franchise?

why do you believe you can successfully operate a fab'rik franchise?

additional information or comments that you might like to share with us in evaluating your Request for Consideration:

5. Other Information

How did you become aware of this franchise opportunity?
I certify that the information furnished in this fab'rik Franchise Request for Consideration is true and correct. I authorize fab'rik to make any additional credit/character checks which it deems necessary.
name	date