Form 3401 - Telephone Solicitation Registration Statement Page 3
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7D. Who has, during the previous seven tax years, filed a bankruptcy, been adjudged a bankrupt,
been reorganized due to insolvency, or has been a principal, director, officer, trustee, general or
limited partner, or had management responsibilities of a corporation, partnership, joint venture, or
other business entity that has filed in bankruptcy, been adjudged a bankrupt, or been reorganized
due to insolvency while the person held that position or within one year after the date on which the
person last held that position.
Under (A), (B), and/or (C), identify the court or administrative agency rendering the conviction, judgment,
or order, the docket number of the matter, the date of conviction, judgment, or order, and the name of the
governmental agency, if any, that brought the action resulting in the conviction, judgment, or order.
Under (D), include the name and location of the person filing in bankruptcy, adjudged a bankrupt, or
reorganized due to insolvency, and include the date of the filing, judgment, or reorganization order, the
court having jurisdiction, and the docket number of the matter.
14.) Attach a list containing the name and principal residence address of each salesperson who solicits on
behalf of the seller or a copy of the "Employer's Quarterly Report" for employee wages the seller files with
the Texas Workforce Commission. Include the name the salesperson uses while soliciting.
15.) The name and address of the seller's agent in this state, other than the secretary of state, authorized to
receive service of process is:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
***In addition to the above information, complete the enclosed "Appointment of the Secretary of State as
Agent of Service" form and return it with the registration statement.
16.) List below the name and address of each financial institution with which banking or similar monetary
transactions are made by the seller and the identification number of each of the seller's accounts in each
institution.
_____________________________________________________________________________________
_____________________________________________________________________________________
17.) Attach hereto the following information, as applicable.
A . A description of the items being offered for sale.
B . A copy of all sales information and literature, including scripts, outlines, instructions, and
information regarding the conduct of telephone solicitations, sample introductions, sample closings,
product information, and contest or premium-award information, provided by the seller to
salespersons or about which the seller informs salespersons, and a copy of all written material the
seller sends to any purchaser.
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