Form E - Sales Agent Disclosure Form SALES AGENT DISCLOSURE FORM 1. List the persons who will offer or sell franchises in this state. For each person state: A. Name; B. Business address and telephone number; C. Home address and telephone number; D. Present employer; E. Present title; F. Social Security Number; G. Birthdate; and H. Employment during the past five years. For each employment, state the name of the employer, position held, and beginning and ending dates. 2. State whether any person identified in 1. above: A. Has any administrative, civil or criminal action pending alleging a violation of franchise or securities law, fraud, embezzlement, fraudulent conversion, restraint of trade, unfair or deceptive practices, misappropriation of property or any comparable allegations? YES __________ NO __________ B. Had during the ten-year period immediately before the Disclosure Document date: (1) been convicted of a felony or pleaded nolo contendere to a felony charge or been held liable in a civil action by final judgment if the felony or civil action involved a violation of franchise or securities law, fraud, embezzlement, fraudulent conversion, restraint of trade, unfair or deceptive practices, misappropriation of property or comparable violations of law? YES __________ NO __________ 310.111 UFDD PACKET (10/07) American LegalNet, Inc. www.FormsWorkflow.com