Form 10a - Form Of Addendum To Registration Statement To Be Filed By Professional Solicitors Page 5

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Form 10A
Sales Schedule
If the solicitation campaign outlined in this form involves the sale of goods, advertising, or tickets to
an entertainment event, you must complete this page.
15.
If the solicitation campaign involves the sale of a good that will be manufactured by the professional
solicitor or an affiliate of the professional solicitor, attach a description of the relationship that
includes the name, address, and phone number of the manufacturer.
16(A). If the solicitation campaign involves the sale of advertising for a publication, complete the following
Information.
Name of publication:
Anticipated date of distribution
Anticipated geographic area of distribution:
Method of distribution:
Number of copies to be distributed:
16(B). If the publisher is an affiliate of the professional solicitor, attach a description of the relationship that
includes the name, address, and phone number of the publisher.
17(A). If the solicitation campaign involves an entertainment event, complete the following information.
Date and time of event (MM/DD/YYYY):
Location of event:
Seating capacity of event:
17(B). Type of promotion by professional solicitor (check as many as apply):
Telemarketing
Direct mail
Sale to public through mass media
Other (please explain)
17(C). Promotion involves (check as many as apply):
Ticket sales for personal use
Number of tickets:
Sales of tickets to be donated for use by others
Number of tickets:
Charitable solicitation not including sale or donation of tickets
17(D). Indicate any groups accepting donated tickets below. Please attach groups’ written confirmation of
acceptance.
Name:
Number of tickets:
Address:
Phone:
Name:
Number of tickets:
Address:
Phone:
Form 10A
Page 5 of 6
Rev. 07/2007

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