Form 133.35 - Application For Designation As Matching Service Under '109.15
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133.35
State Securities Board
P.O. Box 13167
Austin, Texas 78711-3167
Application for Designation as Matching Service Under '109.15
1.
A pplicant's name: _________________________________________________________
Address: _________________________________________________________________
_________________________________________________________________________
Principal place of business (if applicable): _____________________________________
Telephone: _______________________________________________________________
Applicant is (check one):
Governmental entity
_________
Type: ________________________
Statutory authority:
___________
_______
________________________
Quasi-governmental entity
_________
Type:
________________________
Statutory authority:
___________
_______
________________________
Institution of
Higher Education
_________
Type:
________________________
Accrediting agency:
___________
_______
________________________
Nonprofit corporation
_________
If nonprofit corporation, describe in detail nature of association with
governmental or quasi-governmental entity, or institution of higher
education, identify entity and, if applicable, cite statutory authority:
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
2.
C orrespondent's name: _
________
____________________________________________
Firm (if applicable):
___
_
_______
__________
__________________________________
Address: __________
___
_______
___________
__________________________________
______________________________________
___________________________________
Telephone: _______________________________________________________________
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