IN WITNESS WHEREOF, the parties have signed and delivered this Agreement on the dates noted below, to be effective as of the Effective Date.

POTBELLY FRANCHISING, LLC, an Illinois limited liability company [Name of Franchisee] [Signature] [Print Name] [Signature] Name: [Print Name] DATED: Title: DATED:

EXHIBIT A

TO THE FRANCHISE AGREEMENT BETWEEN POTBELLY FRANCHISING, LLC AND DATED , 20 Effective Date: This Exhibit A is current and complete as of , 20 You and Your Owners 1. Formation and Principals. You were incorporated or formed on , under the laws of the State of . You confirm that you have not conducted business under any name other than your corporate, limited liability company, or partnership name. The following is a list of your managing members, directors, and officers, as applicable, as of the effective date shown above: Name of Each Managing Member/Director/Officer Position(s) Held 2. Owners. The following list includes the full name of each person who is one of your owners (as defined in the Franchise Agreement), or an owner of one of your owners, and fully describes the nature of each owner's interest (attach additional pages if necessary). Owner's Name Percentage/Description of Interest (a) (b) (c)

(d)

1. Name and Address of Person to Receive Notices for Franchisee. (a) (b) Postal Address: (c) E-mail Address: Date is 4. 5. prior written approval. POTBELLY FRANCHISING, LLC, an Illinois limited liability company Identification of Managing Owner. Your Managing Owner as of the Effective (must be one of the individuals listed in paragraph 2 above). You may not change the Managing Owner without our Identification of Operator. Your Operator as of the Effective Date is FRANCHISEE [Signature] [Name of Franchisee] [Print Name] By: [Signature] DATED: [Print Name] Title: DATED:

EXHIBIT B

TO THE FRANCHISE AGREEMENT BETWEEN POTBELLY FRANCHISING, LLC

Source: Item 22 — CONTRACTS (FDD page 79)