Ill. Admin. Code tit. 14 , J, Appendix C, ILLUSTRATION B
_________________ | ) | |
_________________ | ) | SS |
_________________ | ) |
IN THE MATTER OF:
FRANCHISOR:
FRANCHISEE:
BEFORE THE ATTORNEY GENERAL OF ILLINOIS
AS ADMINISTRATOR OF THE FRANCHISE DISCLOSURE ACT
The undersigned franchisor hereby requests the Administrator to authorize release from escrow the sum of , plus accrued interest representing the franchise fee paid by __________________________ on the ___ day of ____________, ______.
The undersigned franchisor hereby represents that it has fulfilled the initial obligations owed to the franchisee under the franchise and other agreements and that the franchisee has commenced doing business.
_________________________ | |
Franchisor | |
________________________ | By: _____________________ |
Escrowee Bank | Name and Title |
________________________ | ________________________ |
Address of Bank | Printed Name of Franchisee |
________________________ | ________________________ |
Phone Number of Bank | Address of Franchisee |
Ill. Admin. Code tit. 14 , J, Appendix C, ILLUSTRATION B