STATE OF CALIFORNIA ­DEPARTMENT OF BUSINESS OVERSIGHT GUIDELINES FOR FRANCHISE REGISTRATION DBO ­ 310.111 (Rev. 11-15) Form A UNIFORM FRANCHISE REGISTRATION APPLICATION (Insert app ID of previous filings of Applicant)_________________ FEE: _____________________ (Enclosed when application is initially filed) APPLICATION FOR (Check only one): REGISTRATION OF AN OFFER AND SALE OF FRANCHISES REGISTRATION RENEWAL STATEMENT OR ANNUAL REPORT AMENDMENT NUMBER ________ TO APPLICATION POST ­EFFECTIVE PRE-EFFECTIVE FILED UNDER SECTION ____________ DATED ____________________________ 1. ______________________________________________________________________________ Full Legal Name of Franchisor: (If applicant is sub franchisor, the name of the sub franchisor.) 2. ______________________________________________________________________________ Name under which the Franchisor is doing or intends to do business 3. ______________________________________________________________________________ Franchisor's principal business address. 4. ______________________________________________________________________________ Name and address of Franchisor's agent in the State of (Name of State) authorized to receive process. 5. ______________________________________________________________________________ Name, address and telephone number of sub franchisors, if any, for this state. 6. ______________________________________________________________________________ Name, address and telephone number of person to whom communications regarding this application should be directed. American LegalNet, Inc. www.FormsWorkFlow.com