STATE OF HAWAII DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS Business Registration Division 335 Merchant Street, Room 203, Honolulu, Hawaii 96813 (808) 586-2722 Filing Fee - $250 Amendment Fee - $250 Renewal Fee - $250 Dishonored Check Fee - $25 APPLICATION FOR FILING OF FRANCHISE OFFERING CIRCULAR: Initial Registration Renewal Registration Amendment 1. Name of Franchisor (or subfranchisor): Name under which the Franchisor is doing or intends to do business: Name of any parent or affiliated company that will engage in business transactions with Franchisees: 2. Franchisor’s principal business address: Name and address of Franchisor’s agent in the State of Hawaii authorized to receive process: 3. State the business form of the Franchisor, whether corporate, partnership, or otherwise. (If corporate, date of organization and State of incorporation): 4. Name, address and telephone number of person to whom communications regarding this application should be directed: 5. Exhibits required by the application are attached hereto and made a part hereof. (Name of Applicant) By (Signature) Title F-1 Rev. 07/07 (OVER) B26 (Fee) B27 (Amendment) B65 (Renewal) American LegalNet, Inc. www.FormsWorkflow.com ) ) ss. ) being first duly sworn on oath deposes and says that he/she is the of the applicant named in the foregoing application, that he/she is authorized to make this verification for and on behalf of said ; that he/she has read the application and all the exhibits, statements and documents attached thereto; that the information contained in the application, exhibits, statements and documents is true to the best of his/her information, knowledge and belief. (Signature of Applicant) Subscribed and sworn to before me this day of Notary Public, State of My commission expires: , 20 . (NOTARIAL SEAL) American LegalNet, Inc. www.FormsWorkflow.com