Illinois Administrative Code
Title 14 - COMMERCE
Part 200 - FRANCHISE DISCLOSURE ACT
Subpart J - REGISTRATION OF SALESPERSONS
Appendix A - Franchise Registration Forms
ILLUSTRATION C - Sales Agent Disclosure Form
Universal Citation: 14 IL Admin Code ยง ILLUSTRATION C
Current through Register Vol. 48, No. 12, March 22, 2024
1. List the persons who will offer or sell franchises in this State. For each person state:
A. Name;
B. Business address and telephone
number;
C. Home address and
telephone number;
D. Present
employer;
E. Present
title;
F. Social security
number;
G. Birthdate; and
H. Employment during the past 5 years. For
each such employment state the name of the employer, position held and
beginning and ending dates.
2. State whether any person identified in 1. above:
A. Has any administrative, civil or
criminal action pending alleging a violation of franchise or securities law,
fraud, embezzlement, fraudulent conversion, restraint of trade, unfair or
deceptive practices, misappropriation of property or any comparable
allegations?
YESNO
B. Has during the 10 year period immediately
before the Offering Circular date:
(1) been
convicted of a felony or pleaded nolo contendere to a felony charge or been
held liable in a civil action by final judgment if the felony or civil action
involved a violation of franchise or securities law, fraud, embezzlement,
fraudulent conversion, restraint of trade, unfair or deceptive practices,
misappropriation of property or comparable violation of law?
YESNO
(2) entered into or been named in any consent
judgment, decree, order or assurance under federal or state franchise,
securities antitrust, monopoly, trade practice, or trade regulation law?
YESNO
(3) been subject to any order of any national
securities association or national securities exchange (as defined in the
Securities and Exchange Act of 1934, 15 U.S.C. 78 a ) suspending or expelling
the person from membership in the association or exchange.
YESNO
C. With respect to each question above
answered "YES" state:
(1) the name of each
person or entity involved;
(2) the
court, agency, association or exchange involved;
(3) a summary of the allegations;
(4) if applicable, the date of the
conviction, judgment, decree, order or assurance; and
(5) the penalty imposed, damages assessed and
nature thereof, terms and conditions of the judgment, decree, order or
assurance.
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