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Illinois Business Opportunity Disclosure Document 5-35 - Illinois
| Illinois Business Opportunity Disclosure Document Form. This is a Illinois form and can be used in Business Opportunity Securities Department Blue Sky Secretary Of State . |
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Illinois Secretary of StateIL BSOP FORM 5-35 Securities DepartmentIllinois Business Opportunity Jefferson Terrace, Ste. 300 A 300 W. Jefferson St.Disclosure Document Springfield, IL 62702 217-782-2256 This disclosure document shall contain the following information as provided in Section 5-35 (b) of the Business Opportunity Sales Law of 1995 (attach additional sheets, if necessary). 1. Name of Seller: Please check one: ? Individual ? Partnership ? Corporation ? Other entity (please specify): A. Names under which the seller (within the last 12-month period)has conducted or intends to conduct business: B. Name of any parent or affiliated company that will engage in business transactions with purchasers or that will take responsibility for statements made by the seller: 2. Names and Residential Addresses of salespersons who will engage in the offer or sale of the Business Opportunity in the State: 3. Names, Titles and Addresses of the sellers officers, principals, agents and other persons responsible for the sellers business activities: American LegalNet, Inc. www.USCourtForms.com Printed by authority of the State of Illinois. April 2005 100 SEC 308 <<<<<<<<<********>>>>>>>>>>>>> 24. Name, Address and Description of any Business Opportunity previously offered by the seller in the past five years: A. Name Address Description Length of time seller has offered Business Opportunity Length of time seller has conducted current business B. Name Address Description Length of time seller has offered Business Opportunity Length of time seller has conducted current business C. Name Address Description Length of time seller has offered Business Opportunity Length of time seller has conducted current business5. For all persons listed in #3, describe each persons business experience, including principal occupations and employers, for the 10-year period preceding the filing date of this disclosure document: A. Educational and professional backgrounds of persons listed above, including names of institutions attended and degrees received, and/or any other information that will demonstrate sufficient qualifications to perform the services proposed: B. List and explain if the seller or any of the persons listed in #3 have been convicted of any felony, or pleaded nolo contendere to a felony charge, or have been the subject of any criminal, civil or administrative proceedings alleging the violation of any business opportunity law, securities law, commodities law, franchise law, fraud or deceit or any other comparable allegations: C. Has filed in bankruptcy, been adjudged bankrupt, been reorganized due to insolvency, or was an owner, principal officer or general partner or any other person that has so filed or was so adjudged or reorganized during or within the last seven years: American LegalNet, Inc. www.USCourtForms.com Printed by authority of the State of Illinois. April 2005 100 SEC 308 <<<<<<<<<********>>>>>>>>>>>>> 36. Name of the person(s) identified in #5, nature of and parties to the action or proceeding, court or other forum, date of the institution of the action, docket references to the action, current status of the action or proceeding, terms and conditions or any order or decree, the penalties or damages assessed and terms of settlement: 7. Initial payment required, or a detailed estimate of the amount of the initial payment to be made to the seller for the purchase of a business opportunity: 8 Detailed description of services the seller agrees to perform for the purchaser: 9. Detailed description of any training the seller agrees to provide for the purchaser: 10. Detailed description of services the seller agrees to perform in connection with the placement of equipment, products or supplies at a location, as well as any agreement necessary in order to locate or operate equipment, products or supplies on a premises neither owned nor leased by the purchaser or seller: 11. Detailed description of any license or permit required in order for the purchaser to engage in or operate the Business Opportunity:12. As required by the State of Illinois, the seller has secured a bond issued by: Name of Surety Company Address of SuretyCompany A SURETY COMPANY AUTHORIZED TO DO BUSINESS IN THIS STATE. BEFORE SIGNING A CONTRACT OR AGREEMENT TO PURCHASE THIS BUSINESS OPPORTUNITY, YOU SHOULD CHECK WITH THE SURETY COMPANY TO DETERMINE THE BONDS CURRENT STATUS. American LegalNet, Inc.American LegalNet, Inc. www.USCourtForms.comwww.USCourtForms.com Printed by authority of the State of Illinois. April 2005 100 SEC 308 <<<<<<<<<********>>>>>>>>>>>>> 413. Detailed description of any representations made by the seller to the purchaser regarding sales or earnings that may be made from this Business Opportunity, including but not limited to, the bases or assumptions for any actual, average, projected or forecasted sales, profits, income or earnings: A. Total number of purchasers who, within a period of three years from the date of the disclosure document, purchased a Business Opportunity involving the product, equipment, supplies or services being offered to the purchaser: B. Total number of purchasers, within three years of the date of the disclosure document, who purchased a Business Opportunity involving the product, equipment, supplies or services and who have actually received earnings in the amount or range specified:14. Describe the elements of any guarantee, including but not limited to, the duration, terms, scope, conditions and limitations made by the seller to a purchaser: 15. Total number of Business Opportunities that are the same or similar in nature to those that have been sold or organized by the seller: A. Names and Addresses of purchasers who have requested and/or received a refund or rescission from the seller within the last 12 months: B. Total number of Business Opportunities the seller intends to offer or sell in this State within the next 12 months:16. Statement describing any contractual restrictions, prohibitions or limitations on the purchasers conduct. (Attach a copy of all Business Opportunity and other contracts or agreements proposed for use or in use in this State, including but not limited to, all lease agreements, option agreements and purchase agreements.) 17. Describe the rights and obligations of the seller and the purchaser regarding termination of the Business Opportunity contract or a g r e e m e n t : American LegalNet, Inc. www.USCourtForms.com Printed by authority of the St
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