Franchise Seller Disclosure Form
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Please indicate your business address.
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please indicate your company name.
*
Date Signed
*
-
Month
-
Day
Year
Date
Is there a pending administrative, criminal, or substantial civil action against you for a violation of franchise, antitrust, or securities legislation, or for fraud, unfair or deceptive practices, or other similar allegations?
*
Yes
No
Had you been convicted of or pleaded no contest to a felony charge within the 10-year period preceding the date of this disclosure document's issuance; or been held liable in a civil action involving an alleged violation of a franchise antitrust or securities law, or allegations of fraud, unfair or deceptive practices, or comparable allegations?
*
Yes
No
Is there a current injunction, restrictive order, or decree in existence as a result of a pending or completed public agency action relating to the franchise, or a Federal, State, or Canadian franchise, securities, antitrust, trade regulation, or trade practice law?
*
Yes
No
Please submit the following information for all applicable cases if you responded "yes" to one or more of the questions above: Names of the parties, Forum, nature and current state of the ongoing action, and Case or proceeding identification number.
*
Yes
No
Signature
*
Submit
Should be Empty: