FORM PFR-06

PROFESSIONAL FUND RAISER (PFR)

JIM RYAN

LIST OF CHARITIES & CONTRACTS

ATTORNEY GENERAL

Attachment

For Whom Fund Raising Services Are to be Provided

PFR NAME __________________________________________________________PFR # 02-________________

MANAGEMENT PERSON(S) WHO PREPARE THIS FORM. _________________________________________

SUBMIT A COPY OF EACH CONTRACT WITH REGISTRATION.

LIST CHARITIES FOR WHOM FUNDRAISTNG SERVICES ARE TO BE PROVIDED.

PROVIDE the following BANK ACCOUNT INFORMATION FOR ALL ACCOUNTS USED TO DEPOSIT FUNDS SOLICITED FOR OR ON BEHALF OF EACH CHARITY LISTED:

Contract Info:

Charity Name, City, State:

Contract

Contract Date:   ___/___/___

CO#

Terms:

Beginning:         ___/___/___

01- ________ _________

Ending:             ___/___/___

Bank Account

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

Acct. #

 Other describe:__________________

Contract Info:

Charity Name, City, State:

Contract

Contract Date:   ___/___/___

CO#

Terms

Beginning:         ___/___/___

01-________ _________

Ending:             ___/___/___

Bank Account

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

Acct. #

 Other Describe:_________________

Contract Info:

Charity Name, City, State:

Contract

Contract Date:    ___/___/___

CO#

Terms:

Beginning:         ___/___/___

01-________ _________

Ending:             ___/___/___

Bank Account

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

Acct. #

 Other Describe:_________________

Contract Info:

Charity Name, City, State:

Contract

Contract Date:   ___/___/___

CO#

Terms:

Beginning:         ___/___/___

01-________ _________

Ending:             ___/___/___

Bank Account

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

Acct. #

 Other Describe:_________________

Contract Info:

Charity Name, City, State:

Contract

Contract Date:    ___/___/___

CO#

Terms:

Beginning          ___/___/___

01-________ _________

Ending:             ___/___/___ 

Bank Account

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

Acct. #

 Other Describe:_________________

COMPLETE AS MANY COPIES OF FORM PFR-06 AS NEEDED TO LIST ALL CHARITIES FOR WHICH FUND RAISING SERVICES ARE TO BE PROVIDED. A COMPLETED COPY OF THIS FORM MUST BE SUBMITTED WITH EACH NEW CONTRACT FILED.

Contract Info:

Charity Name, City, State:

Contract

Contract Date:    ___/___/___

CO#

Terms:

Beginning:         ___/___/___

01-________ _________

Ending:              ___/___/___

Bank Account:

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

Acct #

 Other Describe:

Contract Info:

Charity Name, City, State:

Contract

Contract Date:    ___/___/___

CO#

Terms:

Beginning:         ___/___/___

01-________ _________

Ending:              ___/___/___

Bank Account:

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

Acct #

 Other Describe:

Contract Info:

Charity Name, City, State:

Contract

Contract Date:    ___/___/___

CO#

Terms:

Beginning:         ___/___/___

01-________ _________

Ending:              ___/___/___

Bank Account

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

Acct #

 Other Describe:

Contract Info:

Charity Name, City, State:

Contract

Contract Date:    ___/___/___

CO#

Terms:

Beginning:          ___/___/___

01-________ _________

Ending:              ___/___/___

Bank Account

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

Acct #

 Other Describe:

Contract Info:

Charity Name, City, State:

Contract

Contract Date:    ___/___/___

CO#

Terms:

Beginning:         ___/___/___

01-________ _________

Ending:              ___/___/___

Bank Account

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

Acct #

 Other Describe:

Contract Info:

Charity Name, City, State:

Contract

Contract Date:    ___/___/___

CO#

Terms:

Beginning:         ___/___/___

01-________ _________

Ending:              ___/___/___

Bank Account

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

Acct #

 Other Describe:

Contract Info:

Charity Name, City, State:

Contract

Contract Date:    ___/___/___

CO#

Terms:

Beginning:         ___/___/___

01-________ _________

Ending:              ___/___/___

Bank Account

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

Acct #

 Other Describe: