§200.ILLUSTRATION A. Uniform Franchise Registration Notification Page

File No.
(Insert prior number, if any)
Fee:
(Enclosed at time of initial filing)
Date of Filing:

 

Notification of Filing For (Check only one category):

 

       Registration of an offer or sale of franchises

       Annual Report

       Amendment

 

1.         Name of Franchisor

 

 

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 Illinois authorized to receive process.

 

 

Illinois Attorney General, 500 South Second Street, Springfield, Illinois 62706

 

 

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.

 

(Source:  Amended at 23 Ill. Reg. 11561, effective September 7, 1999)