Form I - Franchise Broker Registration printable pdf download

Form I - Franchise Broker Registration

Form I - Franchise Broker Registration Form

FRANCHISE BROKER REGISTRATION FORM

FEE:$150.00

(To be enclosed by Applicant at

time application is filed)

1. Name of Franchise Broker:_____________________________

2. Franchise Broker’s principal business address and telephone number:

____________________________________________

3. State whether the Franchise Broker:

Has an administrative, criminal or material civil action pending against

that person alleging a violation of franchise, antitrust or securities law, or

alleging fraud, unfair or deceptive practices, or any comparable

allegations?

Yes ___

No ___

If you answered “yes”, please provide:

1. Names of the parties:

2. Forum, nature and current status of the pending action:

3. Case or proceeding identification number:

Has ever been convicted of or pleaded nolo contendere to a felony

charge; or been held liable or enjoined in a civil action by final judgment

or been the subject of a material action involving an alleged violation of a

franchise, antitrust or securities law, or allegations of fraud, fraudulent

conversion or misappropriation of property, unfair or deceptive practices,