Request for Consideration

Fill out the form below to receive a free copy of the Re-Bath Business Model eBook which includes a look at our revenue figures (item 19). One of our Business Development Specialists will reach out within 24 hours to provide details about our home remodeling franchise opportunity, and to answer any questions you may have. We’re looking forward to talking.

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First Name*
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Last Name*
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Home Address*
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City*
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State*
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Zip*
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Day Phone*
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Cell Phone*
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Evening Phone*
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Best Time To Reach You*
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E-mail*
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How Did You Learn About Re-Bath?
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Business Information

Present Employer*
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Position*
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Length of Employment at Current Company*
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What is Your Business Expertise?*
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Business Management Experience?*
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If approved, how soon would you want to start?*
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Location City and State Choice*

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Location Choice*
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Are you a Veteran?*
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Business Information Assets

Cash in Banks*
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Stocks and Bonds*
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401K and Retirement Funds*
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IRA's*
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Real Estate Owned Value*
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Other*
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Total Value*
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Liabilities

Mortgage Owed*
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Bank Loans*
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Other Liabilities*
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Total Liabilities*
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Compute Net Worth*
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Total Assets*
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Less Total Liabilities*
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Net Worth Total*
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Total Liquid Assets Willing to Invest in Business: $*
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Combined Household Income*
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Have you ever filed for bankruptcy?*
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- No
How do you plan to fund your business?*
Have you ever been convicted of a crime?*
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- No
All of the above information is correct and Re-Bath has my permission to verify this information.*
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