DO NOT
SUBJECT TO PUBLIC REVIEW
STAPLE
Charities Program
801 Capitol Way South
PO Box 40234
Olympia, WA 98504-0234
Phone: 360-725-0378
Fax: 360-664-4250
E-mail:
charities@sos.wa.gov
Web Address:
APPLICATION TO REGISTER AS A COMMERCIAL FUNDRAISER
FEE: $300
Make fees payable to “State of Washington”
Check here to request EXPEDITED SERVICE (optional). If checked, please enclose an additional $50 fee.
Please complete entire application or write “n/a” if not applicable. Incomplete applications will not be accepted.
All documents must be typewritten or printed legibly in ink. DO NOT staple or bind application or attachments.
If re-registration, provide organization’s Registration No.#: _____________
Check one:
Initial Registration
Re-registration
NOTE: Renewing organizations must use the Commercial Fundraiser Renewal Form, which is available from the Charities Program.
SECTION 1 - ORGANIZATION INFORMATION
Organization’s Full Legal Name:
Mailing Address:
City, State, ZIP:
NOTE: Please include “c/o” and the name of the firm if designated mailing address is “care of” a law firm or similar entity. You
must include the acronym “PMB” if using a Private Mailbox.
Organization’s Street Address
:
City, State, ZIP:
(if different than mailing)
NOTE: If mailing address is a PO Box or a Private Mail Box (PMB), you must provide a street address. If none, provide city and
state of physical location.
Country:
County
:
(WA State only)
Organization’s Telephone Number: (
)
Organization’s Fax Number: (
)
Organization’s Email Address:
Organization’s Web Address:
ORGANIZATIONAL STRUCTURE
Organization Type (check one, if applicable):
WA State Profit Corporation
Sole Proprietorship
Foreign (out-of-state) Profit Corporation
No organizational structure
Limited Liability Company
Other (describe): ____________________________________
Partnership
UBI
Number
:
FEIN
:
(Unified Business Identifier)
(if located or registered in WA)
(Federal Employer Identification Number)
State of Incorporation
:
Date Incorporated or Established:
(if incorporated)
___________________
(mm/dd/yyyy)
SURETY BOND (REQUIRED)
Has the organization submitted proof of surety bonding in the amount of $15,000 to the Secretary of State? (check one)
Yes
No - Complete the attached Fifteen Thousand-Dollar Fundraiser Bond form on page 6 and submit it with this application.
COMMERCIAL FUNDRAISER’S ALSO KNOWN AS NAMES UNDER WHICH IT WILL SOLICIT
List all the commercial fundraiser’s names (excluding the organization’s full legal name provided above) under which contributions
will be solicited. Include acronyms, abbreviations, shortened names, and DBAs, if any. (Attach an additional sheet if needed)
Application to Register as a Commercial Fundraiser/Rev 7/10
1