Dealer Application Form
Business Name:
Street Address:
City:
State:
Zip Code:
Phone Number:
Fax:
E-Mail Address:
Contact Person:
Title:
Your Business:
Describe your business:
Length of time in business:
I am exploring new profit centers for my business.
Yes
No
I want to get into the bedliner business.
Yes
No
I want to get into the industrial coatings business.
Yes
No
I am currently in the drop in bedliner business.
Yes
No
I am currently in the bolt on bedliner business.
Yes
No
I am currently in the spray on bedliner business.
Yes
No
I want to provide a top quality bedliner/industrial coating for my customers.
Yes
No
I am looking for a way to...
Describe your building and location:
I have extra bays or space that can be converted into service bays.
I would need to build or add-on to create room for service bays.
Your expectations:
I am looking for a primary source of revenue.
I am looking for a secondary source of revenue.
Important note: Our licensing agreement requires that your revenues from your FabickŪ business provide no more than 20% of your gross sales during the first year of your dealership.
If you remain interested after reviewing detailed information on the Fabick opportunity, would you be interested in visiting the Madison location to learn more?
Yes
No
You are, of course, under no obligation. and there will be no pressure. But, if after careful consideration, you apply and are accepted as a dealer, you will be expected to make an investment of over $15,000. Are you capable of making such an investment?
Yes
No
Any other questions or comments:

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