Application To Register As A Commercial Fundraiser - Washington Secretary Of State Page 5
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6Has the charitable organization given the commercial fundraiser authority to expend funds and/or incur obligations on its behalf?
Yes
No
Has the required Fundraising Service Contract Registration Form been submitted to the Secretary of State for this campaign?
Yes
No
Charity Name:
Registration Number:
Address:
Telephone: (
)
Contract Term Begin Date:
Contract Term End Date:
Has the charitable organization given the commercial fundraiser authority to expend funds and/or incur obligations on its behalf?
Yes
No
Has the required Fundraising Service Contract Registration Form been submitted to the Secretary of State for this campaign?
Yes
No
Charity Name:
Registration Number:
Address:
Telephone: (
)
Contract Term Begin Date:
Contract Term End Date:
Has the charitable organization given the commercial fundraiser authority to expend funds and/or incur obligations on its behalf?
Yes
No
Has the required Fundraising Service Contract Registration Form been submitted to the Secretary of State for this campaign?
Yes
No
NOTE: List above only charitable organizations that are required to register under RCW 19.09.065. DO NOT submit copies of
fundraising contracts with this application; each contract must be submitted to the Charities Program separately, along with the
required Fundraising Service Contract Registration Form and a $20 fee.
SECTION 3 - SIGNATURE
By signing this application for registration, the applicant: ( a ) certifies that the information contained in the application and in the
attachments are accurate and true to the best of the applicant’s knowledge; ( b ) irrevocably appoints the Secretary of State to receive
process (notice of lawsuits) in non-criminal cases against the applicant, and under the conditions set out in RCW 19.09.305; and ( c )
certifies that neither the organization nor any of its officers, directors, and principals have been convicted of a crime involving
charitable solicitations, nor been subject to permanent injunction or administrative order under the Washington Consumer Protection
Act (Chapter 19.86 RCW) in the past ten years.
_________________________________ ______________________________ _______________________ ______________
Signature of Owner or Officer
Printed Name
Title
Date
This form may be signed by an officer or owner of the organization.
NOTE: Expedited Service is available for registration documents requiring priority processing. To utilize Expedited Service, please
enclose $50 per registration document (in addition to regular fees), check (√) the box on page one of this document, and write the
word “EXPEDITE” in bold letters on the outside of the envelope. Your request will be processed by the Charities Program within
two working days of submission or as soon thereafter as possible.
Application to Register as a Commercial Fundraiser/Rev 7/10
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