Form Va-1 Notice Of Limited Offering Of Securities printable pdf download

Form Va-1 Notice Of Limited Offering Of Securities

FORM VA-1 Part 1

(Rev. 11/96)

COMMONWEALTH OF VIRGINIA

STATE CORPORATION COMMISSION

DIVISION OF SECURITIES AND RETAIL FRANCHISING

NOTICE OF LIMITED OFFERING OF SECURITIES

PURSUANT TO 21 VAC 5-40-100 OF THE SECURITIES ACT RULES

The issuer shall file this notice with the Division of Securities and Retail Franchising not later than 15

days prior to the first sale of securities in this Commonwealth.

This notice shall be accompanied by a non-refundable filing fee of $250.00. This notice shall be deemed

filed with the division for purposes of the rule as of the date on which the notice is received by the

division.

IF ADDITIONAL SPACE IS REQUIRED TO RESPOND COMPLETELY TO ANY ITEM, PLEASE

ATTACH ADDITIONAL SHEETS.

Name of issuer:_________________________________________________________________

Address of issuer:_______________________________________________________________

City______________________State____ Zip_________ Telephone number________________

Correspondence to whom communications regarding this notice should be directed:

Name:________________________________________________________________________

Address:_______________________________________________________________________

City______________________State____ Zip_________ Telephone number________________

Describe, in summary form, the issuer’s business including but not limited to the operations

being conducted (if the business is not operational, describe when operations will begin):

Describe in summary form the material risk factors to be considered in purchasing the securities:

Describe, in summary form, material assets owned or leased by the issuer’s business and if

leased, describe the material terms:

Describe, in summary form, pending litigation involving the issuer’s business or its officers or

directors relative to the issuer's business:

Issuer’s type of business organization:_______________________________________________

(corporation, partnership, limited liability company, real estate investment trust)

Year in which the issuer was incorporated or organized:_________________________________

State or country in which the issuer was incorporated or organized:________________________

Form Va-1 Notice Of Limited Offering Of Securities