Application for Consideration

Tell us about you and why you want to own a Brass Tap

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I certify that the enclosed information as given is correct and complete. This application does not guarantee or constitute the granting of a franchise from FSC Franchise Co., LLC, it is however understood that the applicant supplies the information contained herein to the best of their knowledge and ability, and the company relies on this information in assessing the desirability and qualification of each applicant.

Applicant Personal Information:

Have you lived outside the United States in the last 5 years or do you have Dual Citizenship?

Yes

No

Applicant Spouse or Business Partner Information:

Applicant Education/Military:

Last Grade Completed 12 11 10 9 8

Previous Employer/Business Experience:

Previous Employer/Business Experience:

Previous Employer/Business Experience:

PERSONAL FINANCIAL STATEMENT

I MAKE THE FOLLOWING STATEMENT OF ALL MY ASSETS AND LIABILITIES ON:

ASSETS:

LIABILITIES:

TOTAL ASSETS MINUS TOTAL LIABILITES = NET WORTH:

MONTHLY INCOME AND EXPENSES

SOURCE OF MONTHLY INCOME

MONTHLY EXPENSES

DO YOU PLAN TO HAVE PARTNER(S)? Yes No

Please give names of partners and % of ownership.

Active? Yes No Active? Yes No

By entering my name in the box below and submitting this form, I certify that the enclosed information as given is correct and complete. This application does not guarantee or constitute the granting of a franchise from FSC Franchise Co., LLC, it is however understood that the applicant supplies the information contained herein to the best of their knowledge and ability, and the company relies on this information in assessing the desirability and qualification of each applicant.

In connection with discussions and evaluation of a possible Brass Tap franchise opportunity, we may disclose non-public, proprietary and/or confidential information (whether in oral, visual or written form) that would reasonably be deemed confidential in nature, whether or not it is marked or otherwise designated as “confidential” (“Confidential Information”). By entering my name below, I agree that I shall use the Confidential Information only for evaluating the possible Brass Tap franchise opportunity and I shall never use the Confidential Information for any other purpose or disclose the Confidential Information to any other person.