Registration Application For An Individual Professional Solicitor - Office Of The Secretary Of State Division Of Public Charities

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The State of South Carolina
1205 Pendleton Street, Suite 525
Telephone: (803) 734-1790
Office of the Secretary of State
Columbia, SC 29201
Fax: (803) 734-1604
Division of Public Charities
charities@sos.sc.gov
REGISTRATION APPLICATION FOR AN INDIVIDUAL PROFESSIONAL SOLICITOR
This application must be submitted prior to any solicitation on behalf of a charitable organization.
Filing Fee - $50.00
Check one: [ ] Initial Registration
[ ] Renewal - Individual Solicitor’s ID: _____________________
Full Name of Individual Professional Solicitor: _____________________________________________________
Name of Employer (Fundraiser Company) : _______________________________________________________
Employer’s ID: ____________________________
Demographic Details
Has your authority to solicit contributions been den ied, cancelled, suspended o r revoked, or has any disciplinary
or legal action been taken against you by any governmental authority or is any action pending in relatio n to any
fundraising activity?
[ ] Yes (If yes, include a brief description below.)
[ ] No
___________________________________________________________________________________________
___________________________________________________________________________________________
Fundraiser Principal Address (Individual’s Home Address)
Home Address: ______________________________________________________________________________
___________________________________________________________________________________________
Fundraiser Company Contact Information (Employer Contact Information)
Name: __________________________________________________ Title: _____________________________
Mailing Address: ____________________________________________________________________________
___________________________________________________________________________________________
Telephone Number: ___________________________________
Fax: _________________________________
Email Address: ______________________________________________________________________________
Fundraiser Governmental Authorities
List all other governmental authorities in which you are registered as a Professional Solicitor: _______________
__________________________________________________________________________________________
__________________________________________________________________________________________
South Carolina Secretary of State
October 2010

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