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Form 10 - Registration Statement To Be Filed By Professional Solicitors, Professional Fund-Raising Counsel, And Commercial Co-Venturers Page 2

Form 10

1(E)

If the address in 1(C) is not in-state, give the principal Massachusetts address, if any:

Address:

City:

State:

Zip Code:

Phone:

Fax:

1(F)

If the registrant is incorporated, please note below:

If you noted “yes,” please attach a copy of the Articles of Incorporation to this form.

1(G)

E ither a Federal ID Number OR a Social Security Number for the registrant:

1(H)

Registrant’s employee(s) or agent(s) who will be primarily responsible for conducting

and supervising campaigns at each office listed above. Attach separate pages if

necessary; include ALL sub-contractors.**

Name:

Title:

Address:

Phone:

Name:

Title:

Address:

Phone:

**Sub-contractors must be registered and bonded with Massachusetts before solicitation occurs.

The registrant holding the contract with the charitable organization is responsible for filing the

contract and any applicable financial report with the Division.

If the registrant currently has a charitable organization for which it will conduct

solicitation or counseling, please place an “X” in the box to the right

If you checked this box, please attach a separate page that lists the name and

address of the charitable organization and the dates of the current or planned campaign.

Massachusetts General Laws Chapter 68, Section 22 states that “Every contract or agreement

between a professional fund-raising counsel or a commercial co-venturer or a professional

solicitor and a charitable organization required to have a certificate of registration pursuant to

[chapter sixty-eight] section nineteen shall be in writing, signed by two officers of the charitable

organization, and filed with the director of the division within ten days after such contract or

agreement is entered into. No solicitation shall be conducted prior to the filing of such contract or

agreement.”

Professional solicitors must complete the Form 10A for every campaign conducted in

Massachusetts. Commercial co-venturers must complete the Form 10B for Massachusetts

campaigns. A copy of the contract with the charitable organization should be attached to both the

Form 10A and the Form 10B. These forms must be submitted before solicitation can occur.

Form 10

Page 2 of 3

Rev. 07/2007

Form 10 - Registration Statement To Be Filed By Professional Solicitors, Professional Fund-Raising Counsel, And Commercial Co-Venturers Page 2

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