Form 10a - Form Of Addendum To Registration Statement To Be Filed By Professional Solicitors

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Form 10A
T
C
M
HE
OMMONWEALTH OF
ASSACHUSETTS
O
A
G
FFICE OF THE
TTORNEY
ENERAL
N
-P
O
/P
C
D
ON
ROFIT
RGANIZATIONS
UBLIC
HARITIES
IVISION
O
A
P
NE
SHBURTON
LACE
B
, M
02108
OSTON
ASSACHUSETTS
Form 10A
Addendum to Registration Statement to be Filed by Professional Solicitors
Please TYPE or CLEARLY PRINT all entries in black ink.
1(A).
Full legal name and any additional names under which the professional solicitor conducts
business:
1(B).
Legal principal place of business:
Address:
City:
State:
Zip Code:
Phone:
Fax:
Email address:
Website (URL):
2(A).
Charitable organization benefiting from this solicitation campaign:
Name:
AGO Account #:
Address:
Phone:
2(B).
Charitable organization’s employee(s) or agent(s) who will be primarily responsible for the
solicitation campaign and who should receive any correspondence related to the campaign:
Name:
Title:
Address:
Phone:
Name:
Title:
Address:
Phone:
3.
Individual to contact, if more information is needed about this form:
Name:
Address:
City:
State:
Zip Code:
Phone:
Email:
Form 10A
Page 1 of 6
Rev. 07/2007

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