Form Application For Professional Fundraiser/mandatory Addendum Form To License Application
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3State of Rhode Island and Providence Plantations
DEPARTMENT OF BUSINESS REGULATION
SECURITIES DIVISION
CHARITABLE ORGANIZATION SECTION
1511 Pontiac Avenue, Bldg. 69-1
Cranston, Rhode Island 02920
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**You can check the status of your application by logging into
https://elicensing.ri.gov
with your
Personal User ID and Password.
If you do not have your Personal User ID and Password, please contact the Division at 401-462-9527.
APPLICATION FOR PROFESSIONAL FUNDRAISER
TH
ANNUAL EXPIRATION: JUNE 30
____
INITIAL APPLICATION
ANNUAL FEE: $240.00
_____RENEWAL APPLICATION
CHECKS PAYABLE TO: GENERAL TREASURER STATE OF RI
E-MAIL ADDRESS_________________________________________
FILE NUMBER (if renewal)__________________________________
1. Name of Organization: _________________________________________________________________________
2. DBA:_______________________________________________________________________________________
3. Address:_____________________________________________________________________________________
____________________________________________________________________________________________
4. Date/Place of Organization: ___________________________________________________________________
5. Form of Organization: ______________________________________________________________________
6. Contact Person and Mailing Address: ____________________________________________________________
___________________________________________________________________________________________
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