Commercial Co-Venturer And Charitable Organization Written Consent Form
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1WRITTEN CONSENT FORM
Commercial Co-Venturer and Charitable Organization
(Haw. Rev. Stat. § 467B-5.5)
Name of Charitable Organization:
Address of Charitable Organization:
FEIN:
Name of Commercial Co-Venturer:
Address of Commercial Co-Venturer:
Email Address of Commercial Co-Venturer:
(Required)
Start Date of Charitable Sales Promotion:
End Date of Charitable Sales Promotion:
Description of Goods or Services Offered to the
Geographic Region/Location of Promotion:
Public:
Describe how the name of the Charitable Organization will be used to promote the event (including any
representation to be made to the public as to the amount or per cent per unit of goods or services
purchased or used that is to benefit the charitable organization):
(Use separate sheet if necessary)
Is the Charitable Organization registered or been granted an exemption from registration to solicit
contributions in Hawaii with the Hawaii Attorney General’s Office? Yes
No
Date when final benefit will be provided to the
The form in which final benefit will be conferred
charitable organization:
on charitable organization (cash, check, etc.)?
On (insert applicable date) ____________________ a copy of the final accounting on a per unit basis
shall be prepared by the Commercial Co-Venturer following the completion of the promotion and shall be
provided to the Charitable Organization. A copy of the final accounting shall be provided to the Hawaii
Attorney General upon request.
Signature of Officer of Charitable Organization:
Signature of Officer of Commercial Co-
Venturer:
_____________________________________
_____________________________________
Print Name: __________________________
Print Name: __________________________
Title:
__________________________
Title:
__________________________
Date:
__________________________
Date:
__________________________
INSTRUCTIONS: PLEASE RETURN COMPLETED FORM VIA MAIL/FACSIMILE TO: Department of the Attorney
General/Tax Division, 425 Queen Street, Honolulu, HI 96813. Facsimile: (808) 586-8116.
Commercial Co Venturer Written Consent.doc
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