Section 200.APPENDIX C Escrow Forms

Section 200.ILLUSTRATION C Franchisee's Petition For Release of Escrowed Funds

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	)	SS
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IN THE MATTER OF:

FRANCHISOR:

FRANCHISEE:

BEFORE THE ATTORNEY GENERAL OF ILLINOIS

AS ADMINISTRATOR FOR THE FRANCHISE DISCLOSURE ACT

The undersigned franchisee hereby requests the Administrator to authorize release from
escrow the sum of $		, plus accrued interest representing the franchise fee paid
by me on the	day of		,	.

The undersigned franchisee hereby represents that the franchisor has not fulfilled the initial obligations owed to me under the franchise and other agreements and that I have not commenced doing business.


				Franchisee Signature
				Printed Name of Franchisee
				Address of Franchisee
Subscribed and sworn to before me this
		day of	,
		.

	Notary Public

(Source: Amended at 23 Ill. Reg. 11561, effective September 7, 1999)