Section 200.APPENDIX A   Franchise Registration Forms

Section 200.ILLUSTRATION B   Supplemental Information

1.     List the following:

A.        The states in which this proposed registration is effective.

B.        The states in which this proposed registration is or will be shortly on file.

C.        The states, if any, which have refused, by order or otherwise, to register this franchise.

D.        The states, if any, which have revoked or suspended the right to offer this franchise.

E.         The states, if any, in which the proposed registration of this franchise has been withdrawn.

2.     With respect to all franchises sought to be registered set forth, in budget form, the total projected financing required by the franchisor to fulfill the franchisor's obligations to provide real estate, improvements, equipment, inventory, training and all other items included in the offering.  Show separately the sources of all of the required funds including any proposed loans or contributions to capital.

(Source:  Amended at 19 Ill. Reg. 16950, effective January 1, 1996)