STATE OF CALIFORNIA DEPARTMENT OF CORPORATIONS CUSTOMER AUTHORIZATION OF DISCLOSURE OF FINANCIAL RECORDS Pursuant to Corporations Code Section 31111 and Government Code Sections 7470 and 7473, any financial institution, wherever situated, possessing financial records of the sale of ____________________________________, a franchise registered under the California Franchise Investment Law, by Name of Franchise _________________________________________________________________________________________ Name of Registrant Under the Franchise Investment Law is hereby authorized to disclose to the California Department of Corporations records of the sale of the above-named registered franchise whether such records relate to accounts which have been closed, accounts which are currently maintained, or accounts which are hereafter established. This authorization is effective as of the date of execution and shall remain effective until five years after the expiration or revocation of the above-named franchise registration, including renewals of such registration. This authorization may not be revoked. The terms used in this authorization shall have the definitions contained in the California Right to Financial Privacy Act (Government Code Section 7460 et seq.) and the Franchise Investment Law (Corporations Code Section 31000 et seq.). The above-named registrant has duly caused this authorization to be signed on its behalf by the undersigned, thereunto duly authorized. Executed on ____________________, 20 ___, at ___________________________________________________ ___________________________ Department of Corporations File Number _____________________________________________________________ Name of Registrant By__________________________________________________________ __________________________________________________________ Title QR 500.265 (Rev.1/01) 2002 © American LegalNet, Inc.