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STATE OF NEW YORK
NYF
DEPARTMENT OF LAW
1-81
BUREAU OF INVESTOR PROTECTION AND SECURITIES
FRANCHISE REGISTRATION APPLICATION
_____________________________________
File No.
______________________________________
(insert file number of previous
filings of Applicant, if any)
FEE:__________________________________
(To be enclosed by
Applicant at time
application is initially
filed)
Date of Application:__________________
APPLICATION FOR (Check only one):
______________ REGISTRATION OF AN OFFER OR SALE OF FRANCHISES
______________ REGISTRATION RENEWAL STATEMENT OR ANNUAL REPORT
AMENDMENT NUMBER ___________ TO APPLICATION
1.
Name of Franchisor _____________________________________________
Name under which the Franchisor is doing or intends
to do business __________________________________________________
2.
Franchisor's principal business address _____________________________
_______________________________________________________________
3.
Name and address of Franchisor's agent in the State of
New York authorized to receive process.
_______________________________________________________________
_______________________________________________________________
4.
Name, address and telephone number of subfranchisors,
if any, for the State of New York ___________________________________
_______________________________________________________________
_______________________________________________________________
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