Individual Professional Solicitor Registration Statement Form - State Of South Carolina Secretary Of State

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The State of South Carolina
Office of the Secretary of State
Public Charities Division
P. O. Box 11350
803-734-1790
Columbia, SC 29211
$50.00 Filing Fee
E-mail
Website
Individual Professional Solicitor Registration Statement
[ ] Initial Registration
[ ] Renewal
Renewals, Enter Fundraiser Registration #: __________
________________
This application must be submitted prior to any solicitation on behalf of a charitable organization.
1.
(a) Full Name of Professional Solicitor:______________________________________________________
(b) Home Address_______________________________________________________________________
_____________________________________________________________________________________
(City)
(State)
(Zip)
(Telephone No.)
2.
Social Security Number: __________________________
Date of Birth: _______________________
3.
Work Address: _________________________________________________________________________
_____________________________________________________________________________________
(City)
(State)
(Zip)
(Telephone No.)
4.
Enter all past and present employment as a professional solicitor. List present employment first, and
include all terms of remuneration agreed upon with PFRs. Attach additional sheets if space is insufficient
for the answer.
(a)
Name of Employer: _____________________________________________________________
Address and Ph. No. _____________________________________________________________
______________________________________________________________________________
Terms of Remuneration: __________________________________________________________
______________________________________________________________________________
Period (Mo/Yr): ________________________________________________________________
(b)
Name of Employer: _____________________________________________________________
Address and Ph. No. _____________________________________________________________
______________________________________________________________________________
Terms of Remuneration: __________________________________________________________

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