Facing Page-Uniform Franchise Registration Application {A}

Form A - Facing Page 7/1/95 UNIFORM FRANCHISE REGISTRATION APPLICATION (Insert file number of previous filings of Applicant) _______ FEE: _____________ (Enclosed when application is initially filed) APPLICATION FOR (Check only one): _____ REGISTRATION OF AN OFFER AND SALE OF FRANCHISES _____ REGISTRATION RENEWAL STATEMENT OR ANNUAL REPORT AMENDMENT NUMBER ____TO APPLICATION FILED UNDER SECTION __________ DATED _____________________ _____ POST-EFFECTIVE _____ PRE-EFFECTIVE 1. Name of Franchisor. (If applicant is subfranchisor, the name of the subfranchisor.) Name under which the Franchisor is doing or intends to do business. 2. Franchisor's principal business address. Name and address of Franchisor's agent in the State of (Name of State) authorized to receive process. 3. Name, address and telephone number of subfranchisors, if any, for this state. 4. Name, address and telephone number of person to whom communications regarding this application should be directed. American LegalNet, Inc. www.USCourtForms.com