Registration Application For An Individual Professional Solicitor - South Carolina Secretary Of State Page 2

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6. Have you ever been the subject of a criminal conviction, including guilty or nolo contendere pleas, involving any
charitable solicitations act, fraud, dishonesty or false statement in a jurisdiction within the United States?
____No ____ Yes If yes, provide a full description. Attach a separate sheet if necessary.
_______________________________________________________________________________________
_______________________________________________________________________________________
Please read each of the following items. After reading each item, sign your initials in the space provided at the left of
each numbered item. Your application cannot be accepted unless you read and initial each item.
I acknowledge that at the initial time of solicitation of any person in the state of South Carolina:
_____ 1. I must disclose my status as a professional or paid solicitor upon solicitation of any potential donor.
_____ 2. I must disclose the registered true name of the professional fundraising organization for which I work and the
registered true name, location, and purpose of the charitable organization for which I am soliciting.
I acknowledge that upon the oral or written request of the solicited party:
_____ 3. I must disclose the percentage of gross receipts with which the professional solicitor is compensated, including the
amount the professional solicitor must be reimbursed as payment for fundraising costs.
_____ 4. I must disclose the guaranteed minimum percentage of gross receipts to be remitted or retained by the charitable
organization, excluding the amount which the charitable organization must pay for fundraising costs.
I acknowledge that upon the oral or written request by the solicited party, I must deliver to the solicited party within
fifteen business days of the request:
_____ 5. A financial statement of the charitable organization disclosing assets, liabilities, fund balances, revenue and
expenses for the preceeding fiscal year. The financial statement must be the most recently submitted annual financial report
pursuant to S.C. Code of Laws Section 33-56-60.
_____ 6. A copy of the professional solicitor’s or charitable organization’s current registration certification from the
Secretary of State.
I further acknowledge that:
_____ 7. If I fail to comply with the provisions of the South Carolina Solicitaion of Charitable Funds Act, I or my employer
may be subject to an administrative fine not to exceed two thousand dollars ($2,000) for each separate violation.
_____ 8. An offense committed in violation of S.C. Code of Laws Section 33-56-90 is considered to have been committed at
the place where the solicitation either was initiated or was received.
I, the applicant, certify under the penalty of perjury, that I have read and understand each of the items above. Furthermore, I
certify that the information furnished in this application and all attached supplementary information is true and correct to the
best of my knowledge, information and belief. I understand that the giving of false or incorrect information may constitute a
misdemeanor carrying a penalty upon conviction of a fine of not more than two thousand dollars ($2,000.00) or
imprisonment for not more than one year, or both, for a first offense. A second or subsequent offense may constitute a
felony carrying a penalty upon conviction of a fine of not more than five thousand dollars ($5,000.00) or imprisonment of
not more than five years, or both.
_________________________________________
Print Name
_________________________________________
Signature
Date
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