State of Washington P.O. Box 9033 · Olympia, Washington 98507-9033 Telephone (360) 902-8760 · TDD (360) 664-8126 · FAX (360) 902-0524 · http://www.dfi.wa.gov/securities DEPARTMENT OF FINANCIAL INSTITUTIONS DIVISION OF SECURITIES Business Opportunity Application (Check only one): REGISTRATION......... $200 RENEWAL ................. $125 AMENDMENT... ........$ 30 Registration No. BO - ________ If assigned I. Name of applicant (the entity is offering the business opportunity) ___________________________________________________________ 2. Name under which the applicant is doing or intends to do business, if any (d/b/a) ___________________________________________________________ 3. Applicant's principal business address Telephone ___________________ FAX ___________________ 4. Person to whom communications regarding this application should be directed: Name ____________________________ Firm or Company _________________________________________ (if different than above) Address (if different than above) _________________________________________________________ Email ____________________________________________________ Telephone ___________________ FAX ___________________ American LegalNet, Inc. www.FormsWorkFlow.com Terms of Submission. In submitting this application, the Applicant: · Irrevocably appoints, pursuant to RCW 19.110.090, the Director of the Department of Financial Institutions its agent for service of process in any suit, proceeding, or action arising out of, or founded upon, the sale or lease of a business opportunity within the State of Washington. Service upon the Director under this appointment may be made by registered or certified mail and is as valid and binding as if due service had been made on the Applicant. Certifies under penalty of perjury under the laws of the State of Washington that the information provided in this application and the exhibits thereto is true and correct. · Signed this __________ day of __________, 20______.at ________________ (Place) ________________________________________ Signature ______________________________________________________ Printed Name __________________________________________________________ Title Exhibits to Application EXHIBIT 1 -- Attach a copy of the disclosure document or, if applying for a renewal or amendment, the amended disclosure document. (See RCW 19.110.070 and 19.110.050) EXHIBIT 2 -- Attach a copy of the business opportunity contract. (See RCW 19.110.110) EXHIBIT 3 -- Attach a copy on the Applicant's financial statement (see RCW 19.110.070(10) 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 copy 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 have a surety bond trust account meeting the requirements of RCW 19.110.100. American LegalNet, Inc. www.FormsWorkFlow.com