Fillable IL BSOP FORM 5-35 Illinois Business Opportunity Disclosure (Illinois Secretary of State)

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IL BSOP FORM 5-35 Illinois Business Opportunity Disclosure (Illinois Secretary of State)

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Illinois Secretary of State
Securities Department
421 E. Capitol Ave., 2nd Floor
Springfield, IL 62701
217-782-2256
IL BSOP FORM 5-35
Illinois Business Opportunity
Disclosure Document
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 seller’s officers, principals, agents and other persons responsible for the seller’s business activities:
Printed by authority of the State of Illinois. November 2015 — 100 — SEC 308.1
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).
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4. Name, Address and Description of any Business Opportunity previously offered by the seller in the past five years:
A.
B
.
C.
5. For all persons listed in #3, describe each person’s 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:
Name
Description
Address
Length of time seller has offered Business Opportunity Length of time seller has conducted current business
Name
Description
Address
Length of time seller has offered Business Opportunity Length of time seller has conducted current business
Name
Description
Address
Length of time seller has offered Business Opportunity Length of time seller has conducted current business
6. 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:
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 BOND’S CURRENT STATUS.
Name of Surety Company Address of Surety Company
13. 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 purchaser’s 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
agreement:
18. Statement accurately describing the grounds upon which the purchaser may initiate legal action to terminate the Business Opportunity
contract or agreement:
1
9. Copy of the most recent audited financial statement of the seller, prepared within 13 months of the first offer in this State, along with a
statement of any material changes in the financial condition of the seller from that date must be attached.
20. States in which this Business Opportunity is registered:
21. States in which this disclosure document is on file:
22. States that have denied, suspended or revoked the registration of this Business Opportunity:
23. Section entitled “Risk Factors” containing a series of short concise statements summarizing the principal factors that make this Business
Opportunity a high-risk or one of a speculative nature. Each statement shall include cross-reference to the page on which further
information regarding that risk factor can be found in this disclosure document.
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IL BSOP FORM 5-35 Illinois Business Opportunity Disclosure (Illinois Secretary of State)

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Completed 28 August 2020

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