Uniform Franchise Registration Application Page 2

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Certification
I certify and swear under penalty of law that I have read and know the contents of this
application, including the Franchise Disclosure Document with an issuance date of
_________________
attached as an exhibit, and that all material facts stated in all those documents are accurate and
those documents do not contain any material omissions. I further certify that I am duly
authorized to make this certification on behalf of the Franchisor and that I do so upon my
personal knowledge.
Signed at _______________ , ____________on ______________ ____ , 20__
Franchisor: ___________________
By: _________________________
Print Name: ___________________
Title:_________________________
STATE OF____________)
)
Name of Entity________________
COUNTY OF __________)
Personally appeared before me this ___ day of __________, 20__, the above-named
____________________, to me known to be the person who executed the foregoing application
(as _____________________ of the above name applicant) and, after being administered an oath
and duly sworn, swore upon oath that said application, and all exhibits submitted herewith, are
true and correct.
Notary Public
________________
(NOTARIAL SEAL)
My Commission Expires: ________________

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