PO Box 9033 Olympia, WA 98507-9033 Phone: 360-902-8760 FAX: 360-586-5068 Department of Financial Institutions Securities Division Business Opportunity Application (Check only one): Registration No. BO- REGISTRATION......... $200 RENEWAL .................. $125 AMENDMENT… … .… .$ 30 I. If assigned Name of applicant 2. Name under which the applicant is doing or intends to do business (d/b/a) 3. Applicant’ principal business address s Telephone number FAX Number 4. Person to whom communications regarding this application should be directed: Name Firm or Company Address Telephone number FAX Number I certify under penalty of law that I have read this application and the exhibits attached hereto and incorporated herein by reference, and know the contents thereof and that the statements therein are true and correct to the best of my knowledge. Signed this __________ day of __________, 19______. Signature(s) of applicant: ________________________________________ ____________________________________________________________ By __________________________________________________________ Title ________________________________________________________ CORPORATE SEAL (If Applicable) ss. STATE OF ___________________________________________________ COUNTY OF _________________________________________________ Personally appeared before me this ________________ day of _______________________________________, 19 __________ the above-named _________________________________________________ and __________________________________________, to me known to be the person(s) who executed the foregoing application (as ______________________________________________ _____________________________________________________ the applicant) and (each), being first duly sworn upon oath that said application and all exhibits submitted herewith, are true and correct. Notary Public _________________________________________________ NOTARIAL SEAL SC-610-234 (R/1/95 Page 1 of 3 American LegalNet, Inc. www.USCourtForms.com Exhibits to Application EXHIBIT 1 — Attach executed irrevocable Consent to Service of Process. (A person who has filed a consent in connection with a previous registration need not file another.) EXHIBIT 2 — Attach a copy of the disclosure document. (Or the amended disclosure document if renewal or amendment.) EXHIBIT 3 — Attach a copy of the business opportunity contract. EXHIBIT 4 — Include copies of all advertisements intended to be used in connection with the offer and sale of the business opportunity. EXHIBIT 5 — Surety Bond or Trust Account proof. If the seller makes any guarantee that the purchaser will earn an income greater than or equal to the price paid for the business opportunity, the seller shall attach a $50,000 surety bond or proof of a $50,000 trust account in the name of the state of Washington for the benefit of the state and any person injured by any violation of the Business Opportunity Fraud Act or the seller’ breach of any business opportunity obligation or contract. s The bond shall be from a surety company authorized to do business in Washington or the trust account must be maintained in a bank or savings institution located in the state of Washington. Business Opportunity Contract Requirements In addition to other contractual provisions, the seller’ business opportunity contract shall observe the following statutory requirements s set forth in Section 11, Chapter 155, Laws of 1981: 1. Every business opportunity contract shall be in writing and shall be dated and signed by the purchaser. 2. The seller shall provide the purchaser with a copy of the completed contract at the time the purchaser signs the contract. 3. The seller may not receive any consideration before the purchaser signs a business opportunity contract. 4. The contract shall include the following notifications, in ten point type, immediately above the space for the purchaser’ signature: s a. “DO NOT SIGN THIS CONTRACT IF ANY OF THE SPACES FOR AGREED TERMS ARE BLANK.” b. “DO NOT SIGN THIS CONTRACT UNLESS YOU RECEIVED A WRITTEN DISCLOSURE DOCUMENT FROM THE SELLER AT LEAST FORTY-EIGHT HOURS BEFORE SIGNING.” c. “YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME YOU SIGN IT.” d. “YOU HAVE SEVEN DAYS EXCLUSIVE OF SATURDAY, SUNDAY, AND HOLIDAYS TO CANCEL THIS CONTRACT FOR ANY REASON BY SENDING WRITTEN NOTICE TO THE SELLER BY CERTIFIED MAIL, RETURN RECEIPT REQUESTED. NOTICE OF CANCELLATION SHOULD BE MAILED TO: SELLER’ NAME AND BUSINESS STREET ADDRESS S THE NOTICE MUST BE POSTMARKED BEFORE MIDNIGHT OF THE SEVENTH DAY EXCLUSIVE OF SATURDAY, SUNDAY, AND HOLIDAYS AFTER YOU SIGN THE CONTRACT. THE SELLER SHALL RETURN ALL DEPOSITS AND PAYMENTS WITHIN TEN DAYS AFTER RECEIPT OF YOUR CANCELLATION NOTICE. YOU MUST MAKE AVAILABLE TO THE SELLER ALL EQUIPMENT, PRODUCTS, AND SUPPLIES PROVIDED BY THE SELLER WITHIN TEN DAYS AFTER RECEIPT OF ALL REFUNDED DEPOSITS AND PAYMENTS. SC-610-234 (R/1/95 Page 2 of 3 American LegalNet, Inc. www.USCourtForms.com POWER OF ATTORNEY FOR CONSENT TO SERVE KNOW ALL PERSONS BY THESE PRESENTS: That _______________________________________ of _____________________________________________ a company, corporation, association, joint stock company, co-partnership, trustee or individual (strike words not applicable), hereinafter referred to as the “company”, organized and doing business under and by virtue of the laws of the State of _________________________ for the purpose of procuring authority to do business under the provisions of the Business Opportunity Fraud Act of Washington, Chapter 19.110 RCW, does hereby make and give this irrevocable written consent that in suits, proceedings and action arising out of or founded upon the sale or lease of a business opportunity within the State of Washington, the service of the Director of the Department of Financial Institutions of any notice, process or pleading, therein shall be as valid and binding as if due service had been made on said company. IN WITNESS WHEREOF, the said _____________________________________________ , a company, corporation, association, joint stock company, co-partnership, trustee, individual (strike words not applicable), has hereunto affixed signatures thereof authorizing the same and has caused these presents to be executed by the President and Secretary, and authenticated by the corporate seal thereof, the ________ , day of ________________ , A.D. 19______, in accordance with the resolution of the Board of Directors (trustees or managers of the corporation or association) thereof authorizing the same. (CORPORATE SEAL) ____________________________________________________ Name or signature of applicant Attest: _______________________________________________ (Secretary) By _________________________________________________ (President, Trustee, Manager) (Strike words not applicable) (If a co-partnership or company, all members thereof must sign.) _____________________________________________________ (Individual) It is requested that a copy of any notice, process or pleading served hereunder be mailed to: NAME ______________________________________________________________________________________________________ ADDRESS ___________________________________________________________________________________________________ CORPORATE ACKNOWLEDGMENT State of ________________________ County of ______________________ .ss On this ________ day of ________________, A.D. 19_______, before me personally appeared _______________________________ ___________________ is President and _____________________ is Secretary of the company whose name is subscribed to the foregoing instrument, that the seal affixed hereto is the seal of said corporation, and that the instrument was signed and sealed on behalf of said corporation by authority of its Board of Directors, and the said, _________________________________ and acknowledged to me that they executed the same as their free and voluntary act and deed of such corporation, for the uses and purposes therein set forth. Given under my hand and seal the day and year last above written. ____________________________________________________ (OFFICIAL SEAL) Notary Public in and for the State of ______________________ Residing in __________________________________________ INDIVIDUAL ACKNOWLEDGMENT State of ________________________ County of ______________________ .ss On this ________ day of ________________, A.D. 19_______, before me personally appeared _______________________________ to me known to be the identical person . . . named in and who executed the foregoing instrument, and acknowledged to me that __________ _______________________________ executed the same as _____________________________ free and voluntary act and deed for the uses and purposes herein set forth. Given under my hand and seal the day and year last above written. ____________________________________________________ (OFFICIAL SEAL) Notary Public in and for the State of ______________________ Residing in __________________________________________ SC-610-234 (R/1/95 Page 3 of 3 American LegalNet, Inc. www.USCourtForms.com