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EXHIBIT

TO FRANCHISE

DISCLOSURE DOCUMENT

Compliance Certification

As you know, [name] (XXX) and you are preparing to enter into a franchise agreement, an area franchise agreement, and/or an area development agreement. The purpose of this questionnaire is to determine whether any statements or promises were made to you that XXX has not authorized or that may be untrue, inaccurate, or misleading. Please review each of the following questions carefully and provide honest and complete responses to each question. Please note that this certification must be executed before a notary public or other officer authorized to accept oaths.

1. Have you received and personally reviewed the franchise agreement, area franchise agreement, and/or area development agreement, as the case may be, and each exhibit attached to it?

Yes ________________ No ________________

2. Do you understand all of the information in the franchise agreement, area franchise agreement, and/or area development agreement, as the case may be, and each exhibit attached to it?

Yes ________________ No ________________

If no, what parts of the agreement(s) do you not understand? (Attach additional pages, if necessary.)

________________________________________________

________________________________________________

________________________________________________

________________________________________________

________________________________________________

3. Have you received and personally reviewed XXX’s uniform franchise disclosure document (FDD) that was provided to you?

Yes ________________ No ________________

4. Did you sign a receipt for the FDD indicating the date you received it?

Yes ________________ No ________________

5. Do you understand all of the information in the FDD and any state-specific addendum to the FDD?

Yes ________________ No ________________

If no, what parts of the FDD and/or addendum do you not understand? (Attach additional pages, if necessary.)

________________________________________________

________________________________________________

________________________________________________

________________________________________________

________________________________________________

6. Have you discussed the benefits and risks of becoming a XXX franchisee with an attorney, an accountant, or other professional advisor?

Yes ________________ No ________________

7. Do you understand that the success or failure of your XXX store(s) will depend in large part on your skills and abilities, competition from other concepts, interest rates, inflation, labor and supply costs, lease terms, and other economic and business factors?

Yes ________________ No ________________

8. Has any employee or other person speaking on behalf of XXX made any statement or promise concerning the revenues, profits, or operating costs of any XXX store operated by XXX or its franchisees?

Yes ________________ No ________________

9. Has any employee or other person speaking on behalf of XXX made any statement or promise regarding the amount of money you may earn in operating a XXX store?

Yes ________________ No ________________

10. Has any employee or other person speaking on behalf of XXX made any statement or promise concerning the total amount of revenue that will or may be generated by a XXX store?

Yes ________________ No ________________

11. Has any employee or other person speaking on behalf of XXX made any statement or promise regarding the costs you may incur in operating a XXX store that is contrary to or different from the information in the FDD?

Yes ________________ No ________________

12. Has any employee or other person speaking on behalf of XXX made any statement or promise concerning the likelihood of success that you should or might expect to achieve from operating a XXX store?

Yes ________________ No ________________

13. Has any employee or other person speaking on behalf of XXX made any statement, promise, or agreement concerning the advertising, marketing, training, support service, or assistance that XXX will furnish to you that is contrary to, or different from, the information in the FDD?

Yes ________________ No ________________

14. Have you entered into any binding agreement with or paid any money to XXX concerning the purchase of this franchise before today?

Yes ________________ No ________________

15. Did you receive the FDD at least 14 calendar days before today?

Yes ________________ No ________________

16. Do you understand that the initial franchise fee is nonrefundable under your franchise agreement and that you will forfeit the initial franchise fee if the store is not developed?

Yes ________________ No ________________

17. Do you understand that store expenses may exceed store receipts, particularly in the initial periods of operation, and that you may be required to invest additional working capital to maintain store operations?

Yes ________________ No ________________

18. If you have answered “yes” to any one of questions 8–14 or “no” to questions 15–17, please provide a full explanation of each “yes” answer in the following blank lines. (Attach additional pages, if necessary, and refer to them below.) If you have answered “no” to each of questions 8–14, please leave the following lines blank.

________________________________________________

_______________________________________________

________________________________________________

________________________________________________

________________________________________________

Please understand that your responses to these questions are important to us and that we will rely on them. By signing this questionnaire, you are representing that you have responded truthfully to the above questions.

The undersigned applicant(s) swear(s) under oath that the statement and facts set forth above in the foregoing compliance certification are true and correct.

| | |APPLICANT: |

|Dated: ____________ | |By: /s/____________ |

| | |[Typed name of applicant] |

|STATE OF MICHIGAN |) |

|________ COUNTY |) |

| | |

Signed and sworn to before me in [county] County, Michigan, on [date].

|/s/____________ |

|[Notary public’s name, as it appears on application for commission] |

|Notary public, State of Michigan, County of [county]. |

|My commission expires [date]. |

|[If acting in county other than county of commission: Acting in the County of [county].] |

| | |APPLICANT: |

|Dated: ____________ | |By: /s/____________ |

| | |[Typed name of applicant] |

|STATE OF MICHIGAN |) |

|________ COUNTY |) |

| | |

Signed and sworn to before me in [county] County, Michigan, on [date].

|/s/____________ |

|[Notary public’s name, as it appears on application for commission] |

|Notary public, State of Michigan, County of [county]. |

|My commission expires [date]. |

|[If acting in county other than county of commission: Acting in the County of [county].] |

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