SUPPLIER

FRANCHISE AGREEMENT FOR BRAND DISTRIBUTION IN KANSAS

(Name of Supplier)
hereby appoints ________________________________________________________________
(Name of Distributor)
as its exclusive distributor for the brands listed below for the entire State of Kansas (or as

indicated on the attached Kansas map), effective _____________________, 20_____.

Appointed by Supplier: Accepted by Distributor:

(Supplier Permit Number) (Distributor License Number)

(Company Name) (Company Name)

(Address) (Address)

(Authorized Signature) (Authorized Signature)

(Title) (Title)

(Date Signed) (Date Signed)

List of Brands:

ABC-1004 Rev. 3.5.07