Section 200.APPENDIX A   Franchise Registration Forms

Section 200.ILLUSTRATION A   Uniform Franchise Registration Notification Page

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)