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Date Issued:
Name of Lice nsee/Ve ndor: Lice nsee/Ve ndor #:
Regi on:
Name of Factory: Factory #:
Physical Address:
Maili ng Address:
Teleph one #: Fax #:
Name of Con tact:
Facility Name:
Physical Address:
Maili ng Address:
Teleph one #: Fax #:
(Please review in formatio n above, make cha nges on form if n ecessary.)
FACTORY:
Own ership Type of Factory:
Joint Ven ture Part nership Corporati on Privately Owned
Name of Broker/Age nt (if applicable):
Maili ng Address:
Teleph one #: Fax #:
FACILITY (Note: Complete a questi onn aire for each facility locati on)
Own ership Type of Facility:
Joint Ven ture Part nership Corporati on Privately Owned
Foreig n Inv estme nt Other
Year Facility Established:
Name of Pla nt Man ager:
Teleph one #: Fax #:
Articles Produced:
Total Employees at this Facility: Con tract: _ Local:
If con tract workers employed, le ngth of con tract:
Street Address of Dormitories (if applicable):
SUBCONTRACTING FACILITIES OR SISTER COMPANIES
Name(s)
Location(s)
Operati ons performed.
NUMBER OF MACHIN-SSpecify the followi ng:
Number ofEstimated
Number of
Estimated
Machi ne TypeNumberEmployees onMach ineMo nthlyProducti onCutti ng Mach inesCutt ing TablesKni tt ing Machi nesSewi ng Mach inesMaki ng MachinesLoop ing Mach inesProcess ing Mach ines:
Machi ne Type
Number
Employees on
Mach ine
Mo nthly
Producti on
Cutti ng Mach ines
Cutt ing Tables
Kni tt ing Machi nes
Sewi ng Mach ines
Maki ng Machines
Loop ing Mach ines
Process ing Mach ines:
Permapress ing machi nes
Dying mach ines
Stone wash ing mach ines
Other
Weavi ng Machi nes
Yarn maki ng Mach ines
COMPLETED BY:
Name:
Sig nature:
Title:
Date:
Are all employees volun tarily worki ng in this facility? Yes No
a. What procedures en sure/m on itor that all employees are work ing
volun tarily?
Are there any workers in this facility that are prisoners, have been
TOC \o 1-5 \h \z assig ned by the military, or any other branch of gover nmen t?Yes N
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