Disclosure Questionnaire

FRANCHISEE DISCLOSURE QUESTIONNAIRE

As you know, BRAXTON INDEPENDENT ASSOCIATES LTD. D/B/A BRAXTON INDEPENDENT ASSOCIATES and you are preparing to enter into a Franchise Agreement for the operation of a Franchised Center. In this Franchisee Disclosure Questionnaire, BRAXTON INDEPENDENT ASSOCIATES will be referred to as “we” or “us.” The purpose of this Questionnaire is to determine whether and statements or promises were made to you that we did not authorize and that may be untrue, inaccurate or misleading. Please review each of the following questions carefully and provide honest and complete responses to each question.

1. Have you received and personally reviewed the BRAXTON INDEPENDENT ASSOCIATES Franchise Agreement and each exhibit, addendum schedule attached to it?

Yes _____ No _____

2. Do you understand all of the information contained in the Franchise Agreement and each exhibit and schedule attached to it?

Yes _____ No _____

If “No”, what parts of the Franchise Agreement do you not understand? (Attach additional pages, if necessary.)

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3. Have you received and personally reviewed our Disclosure Document we provided to you?

Yes _____ No _____

4. Do you understand all of the information contained in the Disclosure Document?

Yes _____ No _____

If “No”, what parts of the Disclosure Document do you not understand? (Attach

additional pages, if necessary.)

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________________________________________________________________________

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5. Have you discussed the benefits and risks of operating a BRAXTON INDEPENDENT ASSOCIATES Business with a lawyer, accountant or other professional advisor and do you understand those risks?

Yes _____ No _____

6. Do you understand that the success or failure of your business will depend in large part upon your skills and abilities, competition from other businesses, interest rates, inflation, labor and supply costs, lease terms and other economic and business factors?

Yes _____ No _____

7. Has any employee or other person speaking on our behalf made any statement or promise concerning the revenues, profits or operating costs of a BRAXTON INDEPENDENT ASSOCIATES Business that we or our franchisees operate, other than the information set forth in Item 19 of our Disclosure Document?

Yes _____ No _____

8. Has any employee or other person speaking on our behalf made any statement or

promise concerning a BRAXTON INDEPENDENT ASSOCIATES Business that is contrary to, or different from, the information contained in the Disclosure

Document?

Yes _____ No _____

9. Has any employee or other person speaking on our behalf made any statement or promise concerning the likelihood of success that you should or might expect to achieve from operating a BRAXTON INDEPENDENT ASSOCIATES Business?

Yes _____ No _____

10. Has any employee or other person speaking on our behalf made any statement, promise or agreement concerning the advertising, marketing, training, support service or assistance that we will furnish to you that is contrary to, or different from, the information contained in the Disclosure Document?

Yes _____ No _____

11. If you have answered “Yes” to any of questions seven (7) through ten (10), please provide a full explanation of your answer in the following blank lines. (Attach additional pages, if necessary, and refer to them below.) If you have answered “No” to each of such questions, please leave the following lines blank.

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12. Do you understand that in all dealings with you, our officers, directors, employees and agents act only in a representative capacity and not in an individual capacity and such dealings are solely between you and us?

Yes _____ No _____

You understand that your answers are important to us and that we will rely on them.

By signing this Franchisee Disclosure Questionnaire, you are representing that you have responded truthfully to the above questions.

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Name of Franchisee/Applicant

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Date

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Signature

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Name and Title of Person Signing

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