(name)

,

(a corporation organized under the laws of the State of         )

 (a partnership)     (an individual) 

, irrevocably appoints the

(regulatory authority)

and the successors in office, its attorney in the State of

(state)

for service of notice,

process or pleading in any action or proceeding against it arising out of or in connection with

the sale of franchises, or a violation of the franchise laws of

(state)

; and consents that

an action or proceeding against it may be commenced in a court of competent jurisdiction and

proper venue within

(state)

by service of process upon this officer with the same

effect as if the undersigned was organized or created under the laws of

(state)

and had lawfully been served with process in

(state)

.

(name and address)

Date:

,

By:

Title

(SEAL)

By:

Title

(Notarial Seal)

Notary Public

My Commission Expires: