OFFERING QUESTIONNAIRE

Please return this questionnaire, completed with your answers, no later than

to

1. Franchisor, Predecessors and Affiliates

(a) Name: ______
(b) Other business names (Fictitious Business Name, dba):
(c) Main office address: ______, ______, ______ ______
(d) Phone numbers and area:
(e) Facsimile numbers and area:
(f) Form of Legal Entity:
[ ] Corporation
[ ] General Partnership
[ ] Limited Liability Company
[ ] Other
(g) If a corporation:
(1)

Date of incorporation:

(2)

State and county of incorporation:

(3)

Names, addresses, phone/fax numbers of shareholders:

(4)

Names, addresses, phone/fax numbers of members of Board of Directors:

(5)

Names, addresses, phone/fax numbers of officers and other key personnel:

(h) If a general partnership:

(1)

Effective date of formation:

(2)

State and county where partnership was formed:

(3)

Names, addresses, phone/fax numbers of partners and other key personnel:

(i) Other form of business:

(1)

Effective date of formation:

(2)

State and county where business entity was formed:

(3)

Names, addresses, phone/fax numbers of principals and other key personnel:

(j) Describe the Company's business history and experience:

(k) Does the Company sell or has the Company sold other franchises?
[ ] Yes
[ ] No
(1)
If yes, describe franchise and give the dates of franchise offers and sales and states in
which franchises were located or sales activities took place:
(l) Is the Company affiliated with other companies (affiliates) or subsidiaries?
[ ] Yes
[ ] No
(1)

If yes, describe each affiliated company or subsidiary using the format in (g) above:

(m)Does the Company have any predecessors (individuals or companies from whom the Company
has acquired significant assets either directly or indirectly) for the prior
years?
[ ] Yes
[ ] No
(1) If yes, identify each predecessor using the format in (g) above:
(n) Has any affiliate or predecessor conducted a business of the type to be franchised by the
Company?
[ ] Yes
[ ] No
(1)

If yes, describe:

(o) Has any affiliate or predecessor sold franchises similar to the type to be franchised by the

Company?
[ ] Yes
[ ] No
(1)

If yes, describe:

(p) Describe the franchised business (to be owned and operated by the franchisee):
(q) Will the franchisee be required to devote full time efforts to the franchised business?
[ ] Yes
[ ] No
(r) Identify and describe the competition in the industry (other franchised and non-franchised
businesses in the same or similar marketplace):
(s) Describe the services to be offered by the franchised business:
(t) Describe the products to be offered by the franchised business:
(u) Describe the education, special training, experience, and attitude of the ideal franchisee:
(v) Describe the ideal location for the franchised business:
(w) Describe the services and products to be provided by the Company to its franchisees at no extra
cost to the franchisee (other than initial and royalty fees):
(x) Describe the services and products to be sold by the Company to the franchisees:
(y) List the services and products identified in (w) and (x) above which will be sold by Company or
through its affiliates independently from the Franchise Program:
(z) List the services and products listed in (w) and (x) above which are proprietary to the Company,
such as a unique method, formula or recipe:
(aa) Does the Company intend to be the exclusive source of supply or the major supplier to the
franchised business of any services and products?
[ ] Yes
[ ] No
(1)

If yes, list:

(ab) Describe the market demand and customer base for the services and products to be sold by
the franchised business:
(ac) Does the Company have training, operations, marketing techniques, systems, computer
software, other programs, and/or written manuals that could be adapted for use in the Franchised
Program?
[ ] Yes
[ ] No
(1)

If yes, describe:

(ad) Describe the Company's current quality control systems and those to be used in conjunction
with the franchise program:
(ae) List the states and foreign countries in which franchises will be offered and sold during the
first year of operation:
(af)List the states and foreign countries in which franchises will be offered and sold during the
second year:
(ag) Who will sell the franchises e.g. company personnel, independent franchise brokers,
franchise area representatives? Describe the sales force:
(ah) Will the Company sell Master Franchises (Master Franchisee must develop, own and
operate a specified number of franchised units within a geographic territory over a specified term of
years)?
[ ] Yes
[ ] No
(ai) Will the Company sell Subfranchises (Area Representative, typically a local franchisee too, sells
and helps support local franchisees within a geographic region over a specified term of years)?
[ ] Yes
[ ] No
2. Business Experience
List the employment history of each of the Company's directors, officers, partners, and other key
personnel who have management responsibilities relating to the Company's franchising activities for
the prior 5 years (list the actual hire date of initial employment for the earliest employment, even if

the hire date is more than 5 years ago):

(a) Individual's full name:
(b) Current Position (job title) with Company:
(c) Beginning date of current position:
(d) Employment History for past 5 years (repeat as needed):
(1)

Employer:

(2)

Employer's Address and Phone Number:

(3)

Hire Date:

to Termination Date:

3. Litigation
(a) Has the Company, any predecessor, affiliate, or subsidiary of the Company, or any person listed
in Item 2 above:
(1)
Had any administrative, criminal or civil action pending against him, her or it,
alleging a violation of any franchise law, fraud, embezzlement, fraudulent conversion,
restraint of trade, unfair or deceptive practices, misappropriation of property or similar
allegation?
[ ] Yes
[ ] No
(2)
Ever been convicted of any felony or pleaded nolo contendere to a felony charge, or
during the 10-year period prior to the date of this questionnaire, been held liable in a civil
action by final judgment or been the subject of a material complaint or other legal
proceeding, if such felony, civil action, complaint or other legal proceeding involved a
violation of any franchise law, fraud, embezzlement, fraudulent conversion, restraint of
trade, unfair or deceptive practices, misappropriation of property or comparable allegations?
[ ] Yes
[ ] No
(3)
Been made subject to any currently effective injunction or restrictive order or decree
relating to the franchise or under any federal, state or any franchise, securities, antitrust,
trade regulation or trade practice laws as a result of a concluded or pending action or
proceeding brought by a public agency or subject to any currently effective order of any
national securities association or national securities exchange suspending or expelling such

person from membership in such association or exchange?

[ ] Yes
[ ] No
(4)
If the answer to any of the questions set forth in the preceding item is "yes", please
describe the allegations and outcome and provide the name, address and phone number of
the attorney for the person or company:
4. Bankruptcy
(a) Has the Company, any predecessor, affiliate, or subsidiary of the Company, or any persons listed
in Item 2 above, during the 10-year period prior to the date of this questionnaire, been adjudged
bankrupt or reorganized due to insolvency or were any such persons the principal officers of any
company or a general partner in any partnership that was adjudged bankrupt or reorganized due to
insolvency during or within 1 year after the period that such person held such position in such
company or partnership?
[ ] Yes
[ ] No
(1)

If yes, describe:

(b) Has any such bankruptcy or reorganization been filed or is it contemplated that it will be filed
anytime soon?
[ ] Yes
[ ] No
5. Initial Franchise Fee
(a) Will the Company charge an initial franchise fee?
[ ] Yes
[ ] No
(1)

If yes, how much is the fee? When is it paid? In lump sum or by installments?

(b) If the initial franchise fee is paid in installments, what is the effective annual interest rate?
When is the installment(s) due?
(c) Is the initial franchise fee refundable?

[ ] Yes
[ ] No
(1)

If yes, when and why?

(d) Is the initial franchise fee the same fee charged to each franchisee?
[ ] Yes
[ ] No
(1)

If no, describe the method by which the Company will charge differing fees:

(e) How does the Company intend to use the proceeds from receipt of initial franchise fees, e.g.,
earmarked for payment of specified expenses or deposited into the general account?
6. Other Fees
(a) Ongoing Royalty Fee
(1)

Will the Company charge the franchisee an ongoing royalty fee?

[ ] Yes
[ ] No

(2)

If yes, describe:
[ ] Fixed Fee
[ ] Percentage of Gross Sales
[ ] Other: Describe:

(3)

Will the royalty fee be paid

[ ] Weekly
[ ] Monthly
[ ] Quarterly
[ ] Other: Describe:

(4)

Is the royalty fee the same fee charged to each franchisee?

[ ] Yes
[ ] No

(5)

If no, describe the method by which the Company will charge differing fees:

(6)
How does the Company intend to use the proceeds from receipt of royalty fees, e.g.,
earmarked for payment of specified expenses or deposited into the general account?
(7)

Will the Company pay into the Franchise Program Marketing Fund?
[ ] Yes
[ ] No

(8)

If yes, describe:

(b) Local Marketing Expense

(1)
Will the franchisees be required to advertise, promote and otherwise market their
franchised business locally at their own expense?
[ ] Yes
[ ] No
(2)

If yes, describe:

(c) Regional Marketing Fund

(1)
Will the franchisee be required to contribute to regional, cooperative advertising
fund established by the Company?
[ ] Yes
(2)

[ ] No
If yes, describe:

(d) Additional Fees

Please identify the fees below, if any, that the franchisee will be required to pay, in addition to the
fees in (a) through (c) above, to the Company, to any third party at the Company's direction, or to a
person or company affiliated with the Company:

(1)

License fees
[ ] Yes
[ ] No

(2)

Training fees
[ ] Yes
[ ] No

(3)

Lease payments
[ ] Yes
[ ] No

(4)

Service fees
[ ] Yes
[ ] No

(5)

Other fees
[ ] Yes
[ ] No

(6)
If yes, describe in detail the circumstances under which the fees are due, when they
are due, to whom they are paid, and if they are refundable, and under what circumstances:
7. Initial Investment
(a) Complete a breakdown of expense a typical franchisee could be reasonably expected to incur in
connection with the initial investment. Include those expenses that the franchisee will incur even if
they are not required under the franchise agreement. Describe the highs and lows of each itemized
expense listed below, to whom it is paid, when it is due, the method of payment, and if it is
refundable or not:
(1)

Initial Franchise Fee:

(2)

Real property if purchased:

(3)

Real property if leased:

(4)
Equipment, fixtures, other fixed assets, construction, remodeling, leasehold
improvements, decorating costs, whether or not financed by purchase or lease:
(5)

Inventory required to commence operations:

(6)

Security deposits and other prepaid expenses required to begin operation:

(7)

Working capital required to commence operations:

(8)

Any other payments required to commence operations:

(b) Will the Company or a person affiliated with the Company finance any part of the Franchisee's
initial investment?
[ ] Yes
[ ] No
(1)

If yes, describe:

(c) List all expense items that may or will be financed by the Company or its affiliate:
(d) Describe the terms of payment, e.g., down payment, installments, term of repayment, effective
annual interest rate, installment payments of principal and interests for each expense item that may
or will be financed:
8. Restrictions on Sources of Products or Services
(a) Will the franchisee be required to purchase or lease any products, services, supplies, equipment,
or real estate from the Company or from a supplier selected by the Company (not including
suppliers approved by the Company)?
[ ] Yes
[ ] No
(1)

If yes, list categories of such required purchases or leases:

(b) Is any supplier so designated in any way affiliated with the Company, directly or indirectly?
[ ] Yes
[ ] No
(1)

If yes, identify such suppliers:

(c) Will the Company or its affiliates, derive any income, including rebates, discounts, allowances,
or profit, from franchisees' purchases from these designated suppliers?
[ ] Yes
[ ] No
(1)

If yes, describe:

(d) Of the estimated purchases made by franchisee in conjunction with the establishment of the
franchise, what is the percentage of the designated purchases in relation to the entire amount of
franchisee's purchases:
of 100%.
(e) Of the total estimated purchases made by franchisee in conjunction with the ongoing operation
of the franchise, what is the percentage of the designated purchases in relation to the entire amount
of franchisee's purchases:
of 100%.
(f) List the products, services, supplies, fixtures, equipment, inventory, or real estate which the
franchisee will be required to purchase or lease in accord with the Company's specification or from
suppliers approved by the Company:
(g) Describe the method by which the Company specifies products, services, supplies, fixtures,
equipment, inventory, or real estate:
(h) Describe the criteria by which the Company selects approved suppliers and revokes their status
as approved suppliers:
(i) For what categories is the Company or its affiliates an approved supplier?
(j) For what categories is the Company or its affiliates the only approved supplier?
(k) Will the Company or its affiliates derive rebates, discounts, allowances, or other revenue from
such purchases or leases?
[ ] Yes
[ ] No
(1)

If yes, describe:

9. Franchisee's Obligations
(a) Describe in detail the franchisee's obligations regarding:
(1)

Site selection and acquisition/lease:

(2)

Pre-opening purchases/leases:

(3)

Site development and other pre-opening requirements:

(4)

Initial and ongoing training:

(5)

Opening:

(6)

Fees:

(7)

Compliance with standards and policies/Operating Manual:

(8)

Trademarks and proprietary information:

(9)

Restrictions on products/services offered:

(10)

Warranty and customer service requirements:

(11)

Territorial development and sales quotas:

(12)

Ongoing product/service purchases:

(13)

Maintenance, appearance, and remodeling requirements:

(14)

Insurance:

(15)

Advertising:

(16)

Indemnification:

(17)

Owner's participation/management/staffing:

(18)

Records/reports:

(19)

Inspections/audits:

(20)

Transfer:

(21)

Renewal:

(22)

Post-termination obligation:

(23)

Noncompetition covenants:

(24)

Dispute Resolution:

10. Financing
(a) Will the Company or its affiliates finance any of the franchisee's obligations in connection with
the franchised business, such as the payment of the initial franchise fee, equipment or other
purchases, purchase of site, tenant improvements?
[ ] Yes
[ ] No
(1)

If yes, describe the terms and conditions of such financing:

(b) Will the Company enter into an arrangement with a third party, nonaffiliated lender who will
offer financing to franchisees?
[ ] Yes
[ ] No
(1)

If yes, describe the terms and conditions of such financing:

(c) Attach copies of financing instruments (or leases) related to 1 or 2 above.

(d) Will the Company guarantee the franchisee's obligation?
[ ] Yes
[ ] No
(e) Does the Company intend to sell, assign or discount to a third party any note, contract, or other
instrument executed by the franchisee in favor of the Company?
[ ] Yes
[ ] No
(1)

If yes, describe:

(f) Will the Company or its affiliates receive anything of value in exchange for such transfer to a
third party identified in (e) above?
[ ] Yes
[ ] No
(1)

If yes, describe:

11. Franchisor's Obligations

(a) Under the franchise contract, the Company will be required to provide certain services. Other
services may (but are not required to be) provided by the Company. Identify required and optional
services to franchisees and whether the Company will charge for the services provided in addition to
fees described in above:
(1)

Site location Assistance

[ ] Provided by Franchisor
[ ] Optional at Sole Discretion of Franchisor
$

(2)

Additional Fee Charged by Franchisor

Plans and Specifications for Site

[ ] Provided by Franchisor
[ ] Optional at Sole Discretion of Franchisor
$

(3)

Additional Fee Charged by Franchisor

Consultant Hotline/800 Number Assistance

[ ] Provided by Franchisor
[ ] Optional at Sole Discretion of Franchisor
$

(4)

Additional Fee Charged by Franchisor

Grand Opening Promotion

[ ] Provided by Franchisor
[ ] Optional at Sole Discretion of Franchisor
$

(5)

Additional Fee Charged by Franchisor

Opening Inventory, Forms, Signs

[ ] Provided by Franchisor
[ ] Optional at Sole Discretion of Franchisor
$

Additional Fee Charged by Franchisor

(6)

Training at Company's training location, Pre-Opening

[ ] Provided by Franchisor
[ ] Optional at Sole Discretion of Franchisor
$

Additional Fee Charged by Franchisor

(7)
Is franchisee responsible for travel, lodging and incidental expenses related to the
training?
[ ] Yes
[ ] No
(8)

Training On-Site, Pre-Opening

[ ] Provided by Franchisor
[ ] Optional at Sole Discretion of Franchisor
$

(9)

Additional Fee Charged by Franchisor

Training On-Site, Initial Operation

[ ] Provided by Franchisor
[ ] Optional at Sole Discretion of Franchisor
$

(10)

Additional Fee Charged by Franchisor

Computer On-line Operational Support

[ ] Provided by Franchisor
[ ] Optional at Sole Discretion of Franchisor
$

(11)

Additional Fee Charged by Franchisor

Bookkeeping/Management Support
[ ] Provided by Franchisor
[ ] Optional at Sole Discretion of Franchisor

$
(12)

Additional Fee Charged by Franchisor

Sales of Products/Services
[ ] Provided by Franchisor
[ ] Optional at Sole Discretion of Franchisor
$

(13)

Additional Fee Charged by Franchisor

Proprietary Recipes/Formulas/Methods
[ ] Provided by Franchisor
[ ] Optional at Sole Discretion of Franchisor
$

(14)

Additional Fee Charged by Franchisor

Suggested Retail Price Lists

[ ] Provided by Franchisor
[ ] Optional at Sole Discretion of Franchisor
$

(15)

Additional Fee Charged by Franchisor

Confidential Training Manual

[ ] Provided by Franchisor
[ ] Optional at Sole Discretion of Franchisor
$
Additional Fee Charged by Franchisor

(16)

Confidential Operations Manual

[ ] Provided by Franchisor
[ ] Optional at Sole Discretion of Franchisor
$

(17)

Additional Fee Charged by Franchisor

Confidential Marketing (Promotions/Advertising etc.) Manual

[ ] Provided by Franchisor
[ ] Optional at Sole Discretion of Franchisor

$
(18)

Additional Fee Charged by Franchisor

Other:
[ ] Provided by Franchisor
[ ] Optional at Sole Discretion of Franchisor
$

Additional Fee Charged by Franchisor

(b) Describe the Company's initial training program for new franchisees, including number of
course hours, course curricula, when and where training will be held, who must attend, who may
attend, and Company's criteria for successful completion of the initial training program:
(c) Describe the Company's refresher training courses for its existing franchisees, including number
of course hours, course curricula, when and where training will be held, who must attend, and who
may attend the refresher courses:
(d) Identify the training instructors and describe their expertise and employment history with the
Company:
(e) Estimate the reasonable time it will take the typical franchisee to begin operations (from the
effective date of the franchise contract to the first business day):
(f) Describe the factors used by the Company and/or the franchisee to select a suitable site for the
franchised business:
(g) Describe Company's research and development program to identify and strengthen markets,
services and products, communicate changes in the program to its franchisees:
(h) Describe Company's on-going field support to its franchisees:
(i) Describe other obligations that Company is required or may provide to its franchisees:
12. Territory
(a) Will the Company assist the franchisee in obtaining a location for the franchised business?
[ ] Yes
[ ] No
(1)
If yes, describe the criteria for selecting a location and the Company's qualifications
to select appropriate locations:

(b) Will the Company approve the location in its sole discretion?
[ ] Yes
[ ] No
(c) Will the Company or the franchisee have the option to terminate the franchise agreement if no
suitable location is found?
[ ] Yes
[ ] No
(d) Will the Company sign leases or enter into any other commitments to obtain locations for
franchised business site prior to entering into franchise contracts with its franchisees?
[ ] Yes
[ ] No
(e) Will the franchisee operate the franchised business within an identified, geographical territory?
[ ] Yes
[ ] No
(1)

If yes, describe criteria for establishing typical territories:

(f) Will the franchisee's rights to the exclusive territory be determined by franchisee's performance?
[ ] Yes
[ ] No
(1)

If yes:
[ ] Sales volume
[ ] Market penetration
[ ] Other: Describe:

(g) If franchisee is not granted an exclusive territory, describe any restrictions imposed on the
Company or franchisees as to competition for market share:
(h) Will the Company compete with the franchisees in its franchise program by operating

Company-owned outlets in the same or similar businesses?

[ ] Yes
[ ] No
(1)

If yes, describe:

(i) Will the franchisee have the option to open additional franchised businesses at other locations?
[ ] Yes
[ ] No
(1)
If yes, describe conditions under which franchisee may elect to exercise his, her or
its option:
(j) Will the franchisee have the right of first refusal to open additional franchised businesses
nearby?
[ ] Yes
[ ] No
(1)
If yes, describe conditions under which franchisee may exercise the right of first
refusal:
13. Trademarks
(a) List registration number, description of mark, register (if applicable), and registration date of
federal, state and foreign country registrations for trademarks, service marks, logos, slogans, and
other commercial symbols to be used in connection with the Franchise Program:
(b) Will the Company defend its franchisee from lawsuits involving franchisee's use of Company's
commercial symbols?
[ ] Yes
[ ] No
(c) Will the Company pay the franchisee for expenses related to cancellation, change or other
discontinuation of a mark?
[ ] Yes
[ ] No

14. Patents, Copyrights, and Proprietary Information

(a) List registration number, description of patent, register (if applicable), and registration date of
federal, state and foreign country registrations for patents and copyrights to be used in connection
with the Franchise Program:
(b) Furnish the name and phone number of the intellectual property attorney ("patent lawyer") who
is representing the Company:
(c) Will the Company defend its franchisees from lawsuits involving franchisee's use of Company's
intellectual property?
[ ] Yes
[ ] No
(d) Will the Company pay the franchisee for expenses related to cancellation, change or other
discontinuation of a commercial symbol, patent or copyright?
[ ] Yes
[ ] No
15. Franchisee's Participation in Business Operation
(a) Will the franchisee be required to devote full time, exclusive efforts to the operation of the
franchise(s) in the Franchise Program?
[ ] Yes
[ ] No
(1)
If no, must franchisee's manager be required to attend and successfully complete the
Company's initial training?
[ ] Yes
[ ] No
(b) Will franchisee and his, her or its employees be required to enter into agreements related to
protection of trade secrets or non-competition?
[ ] Yes
[ ] No

(1)

If yes, describe:

16. Goods or Services Offered by Franchisee

(a) Will Company place restrictions on the types of services and products the franchisee may sell,
e.g., sell only those services and products approved by Company?
[ ] Yes
[ ] No
(1)

All of the services and products approved by Company?

[ ] Yes
[ ] No
(1)

Describe:

(b) Will Company place restrictions on the franchisee's customer base?

[ ] Yes
[ ] No
(1)

Describe:

17. Renewal, Termination, Transfer, and Dispute Resolution

(a) Identify the length of time of the franchise contract:
(1)

When did the franchise contract become effective?

[ ] At the time the contract is signed
[ ] When Company approves franchisee's location
[ ] Other:

(b) Will other contracts affect the length of the franchise contract, such as the duration of the
location's lease?
[ ] Yes
[ ] No
(1)

Describe:

(c) Is the franchisee required to open for business within a specified length of time?
[ ] Yes
[ ] No
(1)

If franchisee fails to open within the specified time, what happens?

(d) Will the franchisee have the right to terminate the franchise contract before the contract term
expires?
[ ] Yes
[ ] No
(1)

Describe:
[ ] Company's failure to perform material obligations under the franchise contract
[ ] Expiration of location lease
[ ] Failure to find suitable location approved by Company
[ ] Other: Describe:

(e) Under what circumstances will the Company have the right to terminate the franchise contract
before the contract term expires? Describe:
(f) Will the franchisee have the right to sell or assign the franchise contract to someone else?
[ ] Yes
[ ] No
(1)

Under what conditions?

(g) Will Company charge a transfer fee for a change in franchise ownership?
[ ] Yes
[ ] No
$
(1)

Fee.
Automatically upon transfer?

[ ] Yes
[ ] No
(2)

Discretionary with Company?

[ ] Yes
[ ] No

(h) If franchisee or franchisee's controlling owner dies or becomes incapacitated, what rights to
succeed to franchise ownership will franchisee's heirs or other nominee have?
(i) Is franchisee restricted, prohibited from owning or operating, or otherwise prevented from
competing, directly or indirectly, with the Company?
[ ] Yes
[ ] No
(1)

Describe and explain why these restrictions are believed to be necessary:

(j) Will the franchisee have the option to renew the franchise contract?
[ ] Yes
[ ] No
(1)

Describe the conditions of renewal:

(k) Describe franchisee's obligations upon early termination or non-renewal of franchise contract:
[ ] Return confidential manuals
[ ] Change business name, logo etc.
[ ] Cancel phone listings
[ ] Return equipment
[ ] Return inventory
[ ] De-identify location
[ ] Other action necessary to distinguish business from franchised outlets:

(l) Describe Company's obligations upon early termination or non-renewal of the franchise
contract:
[ ] Purchase inventory
[ ] Purchase equipment
[ ] Purchase supplies of proprietary items, e.g., stationery,
[ ] Other:
(1)

How will purchase price(s) be determined?

(m)Describe dispute resolution by arbitration or mediation:

18. Arrangements With Public Figures
(a) Will the Company use the name, likeness, testimonial, or any other participation by a public
figure (celebrity, cartoon character) in conjunction with its Franchise Program?
[ ] Yes
[ ] No
(b) Describe participation, compensation or other benefits received from Company by public figure:
19. Earnings Claims
(a) Do you agree with the following statement:
"The Company does not furnish or authorize its salespersons to furnish any information concerning
the actual or potential sales, costs, income, or profits of the Franchise Program. However, the
Company may provide the franchise buyer of an existing franchised or Company-owned outlet with
information concerning the financial history of the existing outlet under certain limited
circumstances."
[ ] Yes
[ ] No
(1)

If not, why not:

20. List of Franchise Outlets and Summary of Store Status

FRANCHISED OUTLETS SOLD, OPENED, CLOSED FISCAL YEAR ENDING

State

Total Number Outlets Outlets Total Number

Open at Start of F.Y. Opened
Closed Open at End of F.Y.

COMPANY-OWNED AND AFFILIATE-OWNED OUTLETS FISCAL YEAR ENDING

State

Total Number Outlets Outlets Total Number

Open at Start of F.Y. Opened
Closed Open at End of F.Y.

ESTIMATED OPENINGS FOR THE NEXT FISCAL YEAR

State

Franchise Agreements to Be Signed

But Not Operational

Franchises To Be Sold
and Operational

SUMMARY OF FRANCHISE TERMINATIONS, TRANSFERS, OTHER CHANGE OF STATUS

FOR THE FISCAL YEAR ENDING
State

Transferred by Company

Terminated by Company

Not Renewed

21. Financial Statements

Please enclose the franchisor company's financial statements. Financial statements must be
prepared in accordance with generally accepted accounting principles. These financial statements
must be audited by an independent certified public accountant. Unaudited statements may be used
for interim periods. Include the following Financial Statements:
(a) The franchisor's balance sheets for the last 2 fiscal year ends before the application date
In addition, include statements of operations, of stockholders equity and of cash flows for each of
the franchisor's last three fiscal years. If the most recent balance sheet and statement of operations
are as of a date more than 90 days before the application date, then also submit an unaudited balance
sheet and statement of operations as of a date within 90 days of the application date; or
(b) Affiliated company statements
Instead of the disclosure required above the franchisor may include financial statements of its
affiliated company if the affiliated company absolutely and unconditionally guarantees to assume
the duties and obligations of the franchisor under the franchise agreement;
(c) Consolidated and separate statements
When a franchisor owns a direct or beneficial, controlling financial interest in another corporation,
its financial statements should reflect the financial condition of the franchisor and its subsidiaries.
If the applicant is a subfranchisor include separate financial statements for the franchisor and
subfranchisor related entity. Prepare consolidated and separate financial statements in accordance
with generally accepted accounting principles.

22. Contracts
Please enclose samples of all or agreements that the franchisee may reasonably be expected to enter
into with you, your affiliates and others, e.g., the application form, franchise agreement, equipment
lease, sublease, and personal guaranty.
23. Other Documents Provided With Questionnaire
Check below those documents which are being forwarded to your attorney along with this
completed questionnaire:
[ ] If Company is a corporation:
[ ] Articles of Incorporation
[ ] Bylaws
[ ] Corporate minutes, other resolutions
[ ] Share certificate ledgers
[ ] Shareholder agreements
[ ] Major contracts, List:
[ ] If Company is a partnership or other business form:
[ ] Partnership Agreement
[ ] Other owners' agreements, List:
[ ] Major contracts, List:
[ ] Government orders, opinions, decisions that are directly or indirectly related to the
Company and its Franchise Program
[ ] Business licenses
[ ] State authorization to do business
[ ] Foreign country authorization to do business
[ ] Pending applications, registrations of commercial symbols, e.g., trademark, service mark,
logo, slogan

[ ] Pending applications, registrations of patents

[ ] Pending applications, registrations of copyrights
[ ] Samples of all Company's commercial symbols; separately identify and submit samples
of those symbols to be used in conjunction with the franchise
[ ] Marketing materials in use or proposed for use in connection with Franchise Program
[ ] Other:
This questionnaire was completed and submitted by Franchisor's authorized representative on
.
By:
Name and Title
*[
STATE OF
)
COUNTY OF
)
This instrument was acknowledged before me on this day of
.

Notary Public
My Commission Expires:
]*

by