INSTRUCTIONS FOR FRANCHISE SELLER DISCLOSURE FORM (ITEM 2 BUSINESS EXPERIENCE)

When filling out the Franchise Seller Disclosure Form, please make sure you:

Put FIVE YEARS OF BUSINESS EXPERIENCE. If we are franchising in June 2018, we will need business experience all the way back to June 2013. It can go farther back than that, but it must at LEAST be five full years. There should be NO TIME GAPS between each position.
Start with your CURRENT POSITION with the FRANCHISING COMPANY and go back from there. Typically, the position with the franchising company is listed first, then position with the affiliate company (current company business is run under), then previous positions with other employers.
Put a CITY and STATE under “Location.”
Put a START DATE and an END DATE. Please input both MONTH and YEAR for both dates. END DATE can be “Present.”
Put an existing company name for “Name of Employer.” Do NOT input “restaurant” or “self-employed.”
Answer ALL questions on each page of the form and SIGN the last page of the form.

Step 1 of 3

Company Name(Required)

NAME OF FRANCHISOR

List who will solicit, offer or sell franchises for the Franchisor in this state

Name(Required)

Business address and telephone number(Required)

Present employer(Required)

Present title(Required)

Employment during the past five years (or past 10 years if registering in Connecticut). For each employment, state the name of the employer, position held, and beginning and ending dates:

Name of Employer

Position Held

Location

Start Date

End Date

Name of Employer

Position Held

Location

Start Date

End Date

Name of Employer

Position Held

Location

Start Date

End Date

Name of Employer

Position Held

Location

Start Date

End Date

Name of Employer

Position Held

Location

Start Date

End Date

Name of Employer

Position Held

Location

Start Date

End Date

Name of Employer

Position Held

Location

Start Date

End Date

Franchise Disclosure Information.

(Keep this page and the following page separate from Sections 1 and 2 above. Sections 1 and 2 above will be submitted to relevant state franchise administrators with franchise registrations, this Section 3 will not. Submission Required in HI, IL, IN, MY, MN, WA)

State whether the person identified in 1 above:

Has pending against that person any civil actions not listed above(Required)

The name of each person or entity involved

The court, agency, association or exchange involved;

The applicable case or file numbers

The current status of any pending action

A summary of the circumstances and allegations

Applicable conviction, judgment, decree, order, discharge or assurance dates

The date, nature, and issue of any relevant orders; and 7. The penalty imposed, damages assessed and the nature, terms and conditions of any judgments, decrees, orders, assurances, or settlements.

Was a party to any civil action involving the franchise relationship in the franchisor’s last fiscal year. (“Franchise relationship” includes contractual obligations between the franchisor and franchisee relating to the operation of the franchised business, such as royalty payment and training obligations.)(Required)

The name of each person or entity involved

The court, agency, association or exchange involved;

The applicable case or file numbers

The current status of any pending action

A summary of the circumstances and allegations

Applicable conviction, judgment, decree, order, discharge or assurance dates

The date, nature, and issue of any relevant orders; and 7. The penalty imposed, damages assessed and the nature, terms and conditions of any judgments, decrees, orders, assurances, or settlements.

Has ever been a party to any civil action involving the franchise relationship.(Required)

The name of each person or entity involved

The court, agency, association or exchange involved;

The applicable case or file numbers

The current status of any pending action

A summary of the circumstances and allegations

Applicable conviction, judgment, decree, order, discharge or assurance dates

The date, nature, and issue of any relevant orders; and 7. The penalty imposed, damages assessed and the nature, terms and conditions of any judgments, decrees, orders, assurances, or settlements.

Has ever been the subject of any injunctive or restrictive order or decree relating to the franchise or to any foreign, federal, state, or Canadian franchise, securities, antitrust, trade regulation or trade practice law as a result of a concluded or pending action or proceeding brought by any public agency.(Required)

The name of each person or entity involved

The court, agency, association or exchange involved;

The applicable case or file numbers

The current status of any pending action

A summary of the circumstances and allegations

Applicable conviction, judgment, decree, order, discharge or assurance dates

The date, nature, and issue of any relevant orders; and 7. The penalty imposed, damages assessed and the nature, terms and conditions of any judgments, decrees, orders, assurances, or settlements.

Is a party to any proceeding which could make them subject to an injunction or restraining order brought by any public agency or department?(Required)

The name of each person or entity involved

The court, agency, association or exchange involved;

The applicable case or file numbers

The current status of any pending action

A summary of the circumstances and allegations

Applicable conviction, judgment, decree, order, discharge or assurance dates

The date, nature, and issue of any relevant orders; and 7. The penalty imposed, damages assessed and the nature, terms and conditions of any judgments, decrees, orders, assurances, or settlements.

Has been a party in any mediation or arbitration proceeding during the past 6 years?(Required)

The name of each person or entity involved

The court, agency, association or exchange involved;

The applicable case or file numbers

The current status of any pending action

A summary of the circumstances and allegations

Applicable conviction, judgment, decree, order, discharge or assurance dates

The date, nature, and issue of any relevant orders; and 7. The penalty imposed, damages assessed and the nature, terms and conditions of any judgments, decrees, orders, assurances, or settlements.

Has, within the past 15 years, filed as debtor (or had filed against that person a petition under the United States Bankruptcy Code (“Bankruptcy Code”); obtained a discharge of that person’s debts under the Bankruptcy Code; been a principal officer of a company or a general partner in a partnership that either filed as a debtor (or had filed against it) a petition under the Bankruptcy Code; or that obtained a discharge of its debts under the Bankruptcy Code while, or within one year after, the person held the position of officer or general partner in the company.(Required)

The name of each person or entity involved

The court, agency, association or exchange involved;

The applicable case or file numbers

The current status of any pending action

A summary of the circumstances and allegations

Applicable conviction, judgment, decree, order, discharge or assurance dates

The date, nature, and issue of any relevant orders; and 7. The penalty imposed, damages assessed and the nature, terms and conditions of any judgments, decrees, orders, assurances, or settlements.

Is or has been involved in cases, actions or other proceedings under the laws of foreign nations relating to bankruptcy.(Required)

The name of each person or entity involved

The court, agency, association or exchange involved;

The applicable case or file numbers

The current status of any pending action

A summary of the circumstances and allegations

Applicable conviction, judgment, decree, order, discharge or assurance dates

The date, nature, and issue of any relevant orders; and 7. The penalty imposed, damages assessed and the nature, terms and conditions of any judgments, decrees, orders, assurances, or settlements.

For each bankruptcy, state the date of the original filing and the material facts, including the bankruptcy court, and the case name and number. If applicable, state the debtor's discharge date, including discharges under Chapter 7 and confirmation of any plans of reorganization under Chapters 11 and 13 of the Bankruptcy Code.

I certify under penalty of law that I have read this information sheet and know the contents of it and that the statements in it are true and correct.

Name

Date

What services are you interested in?(Required)

Signature

NOTE: Each person who is one of the following for the franchisor company should fill out and sign this form:

Directors,
Trustees,
General Partners,
Principal Officers,
Any other individuals who will have management responsibility related to the sale or operation of franchises,
Franchise Brokers/Sales Agents including Subfranchisors and Area Developer Franchisees,
Officers, directors and other management personnel of your corporate parent and/or affiliates who have management responsibility over the franchises

By submitting this form, you agree that Franchise Creator and its parent company Franchise FastLane may contact you regarding franchise development, franchise sales, and growth services.

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INSTRUCTIONS FOR FRANCHISE SELLER DISCLOSURE FORM (ITEM 2 BUSINESS EXPERIENCE)

NAME OF FRANCHISOR

Employment during the past five years (or past 10 years if registering in Connecticut). For each employment, state the name of the employer, position held, and beginning and ending dates:

State whether the person identified in 1 above

Franchise Disclosure Information.

State whether the person identified in 1 above:

Part of the Franchise FastLane Family

Contact Info

Address

Phone Numbers

Email

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