Uniform Franchise Registration Application Page 3
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3Instruction for Preparing Form A - Uniform Franchise Registration Application
1. Insert the name of the state where the filing is to be made in the first line.
2. For franchisors previously registered, insert the file number of the immediately
preceding filing of the applicant in “File No.”
3. Fill in the amount of the filing fee. A check in U.S. funds drawn on a U.S. bank must
accompany the application.
4. Check one of the lines in the “Application For” section to indicate the type of filing.
5. Line 1: Insert the full legal name of the franchisor.
6. Line 2: Insert the trade name of the franchise being offered.
7. Line 3: Insert the franchisor’s principal business address in the U.S. If a
foreign franchisor does not have a U.S. business address, insert its principal business
address in its home jurisdiction.
8. Line 4: Insert the name and address of the franchisor’s agent in the state authorized to
receive service of process. You should list the appropriate state authority listed in Form C
(if required by the Franchise Filing State). You may also list additional agents for service
of process that have been duly appointed by the franchisor.
9. Line 5: Insert the Franchise Filing States in which the application will be filed.
10. Line 6: Insert the names, address, telephone and facsimile numbers, and e-mail
address of the person to whom communications regarding the Application should be
directed. Identify only one individual. Confirmation of effectiveness will be sent to this
address.
11. Certification: Insert the issuance date of the disclosure document, the city and state in
which the Application was signed, and the date of signing. Insert the franchisor’s name in
the signature block and print or type the name and title of the authorized signer. The
authorized signer should sign on the “By:” line.
12. Complete and sign the jurat.
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