Oregon Department of Justice Fund-Raising Firm
Solicitation Campaign Notice PF-11/PF-21
Official Use Only
1. Name of professional/commercial fund-raising firm:
DOJ Registration #
2. Name of nonprofit beneficiary:
Campaign Start Date:
Campaign End Date:
/ /
/ /
3. Description of fund-raising campaign: (Check all that apply. Attach additional sheets if necessary. See instructions)
Telephone Mail Vending Face-to-Face
*Event Location:
Donations Coupon books Internet
Advertising Event tickets* Email
Other:_____________________________________
Event Date: / /
4. Campaign location: (Attach additional sheets if necessary)
Address(es)
4(b). If the campaign is conducted by telephone, describe how the name(s), telephone number(s), or other
information is configured to appear for caller identification purposes and list the telephone number(s) that will
be displayed.
5. List each different address for the fundraising firm or beneficiary that is included in the campaign materials
and the purpose for that address (attach additional sheets if necessary):
6(a). Does this campaign involve the use of a caging company or similar entity to receive and/or process
contributions relating to this campaign or is there any entity other than the beneficiary and/or fundraising firm
that has access or control over contributions:
Circle one: Yes / No
If Yes, answer questions 6(b) and 6(c) below. If No, skip to question 7
6(b) If yes to 6(a), provide the name and address of the entity:
Name/Address
_____________________________________________________________________________________
6(c) If yes to 6(a), describe any relationship between the fundraising firm and the entity named above, including
any common ownership or control or any involvement that the
fundraising firm had in the selection of the entity
listed in 6(b): ______________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
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Rev 4/13/20
7(a). Name of fund-raising firm’s employee or agent who is in charge of this campaign:
Name: Telephone number/Email
7(b) Who should we contact if we have questions about this campaign or notice?
Name: Telephone number/Email
8. Bank name and account number where funds will be deposited during the campaign: (See instructions)
Bank Name:
9. Required attachment checklist: (Attach all of the following documents, see instructions for further information)
Fund-raising contract
Written disclosure
Written financial plan
Telephone script(s)
Contracts with entities listed in 6(b) above, if
I confirm that the campaign solicitation material (telephone script(s), written disclosure(s) and written
financial plan) has been approved by an official
of all beneficiaries of the campaign. I also confirm my
understanding that a professional fund-raising firm may not solicit funds in the State of Oregon until 10
days after the Office of the Attorney General receives a completed solicitation campaign notice form and
all required attachments. I hereby declare that the foregoing information is true and correct to the best
of my knowledge and belief and that I
understand it is made for use as evidence in court or
administrative proceeding and is subject to penalty for perjury.
________________________________________________________
(signature of declarant)
______________________________________________________
(print name of declarant)
__________________________________________
(date)
Incomplete forms or forms without proper attachments will be returned.
Rev 4/13/20
Charitable Activities Section, Oregon Department of Justice - Charitable Solicitations Act (Oregon Revised Statues 128.801 to 128.898).
Fund-Raising Firm Solicitation Campaign Notice PF-11/PF-21
General Instructions
Professional/commercial fund-raising firms must submit a completed
solicitation campaign notice form for each solicitation campaign. As a
general rule, a notice form is required for each separate fund-raising
contract. This office must receive the completed form at least 10 days
prior to the start of the solicitation campaign. Submit this notice in
addition to the annual registration statement.
Line Instructions
1. Firm Name/Registration Number
Enter the full name of the professional/commercial fund-raising firm
and the Oregon registration number issued to the firm by the
Department of Justice. Also list any assumed business names and all
other firm names to be used by solicitors in this campaign.
2. Beneficiary Name/Campaign Dates
Enter the full name of the nonprofit beneficiary and the start and end
dates of the campaign. The term “beneficiary” refers to each
nonprofit organization that is to receive a portion of the funds raised
and whose name is used in the course of the solicitation campaign.
Important NoteFirms required to submit a financial report for the
campaign must do so within 90 days after the listed ending date.
3. Campaign Description
Indicate the method used to solicit donations. Check all boxes that
apply to this campaign (e.g. telephone appeal, direct mail, and/or
door-to-door), and the items for sale, if any (e.g. coupon books,
entertainment tickets, or merchandise). If applicable, enter the date
and location of the event (e.g. concert, circus, etc.)
4. Campaign Location
Enter the full address of each physical location used to conduct the
solicitation campaign. Also, provide the name of the manager of that
location. If the campaign is conducted by telephone, describe how the
name(s), telephone number(s), or other information is configured to
appear for caller identifications purposes and list the telephone
number(s) that will be displayed. Attach additional sheets if
necessary.
5. Campaign Addresses
List each address that will appear in campaign materials and describe
the purpose for which that address is used. For example, if campaign
materials include a street address for the beneficiary in an
acknowledgment letter, but a post office box for the return of
donations, list each address and describe the context in which that
address appears in campaign materials. For the purposes of this
question, campaign materials include scripts or similar instructions
used by solicitors to provide information to solicitees about the
campaign as well as documents provided to solicitees. You may
respond to this question by attaching a copy of the campaign material
that includes the address and referencing the attachment, assuming the
purpose of the address is evident from those materials.
6. Receiving/Processing Payments
Identify whether the campaign involves the use of a caging company
or similar entity to receive and/or process contributions relating to this
campaign or if there is any entity other than the beneficiary and/or
fundraising firm that has access or control over such contributions. If
yes, provide the name and address of the entity in 6(b) and identify
any relationship between the entity and the fundraising firm in 6(c).
Relationships that should be disclosed include, but are not limited to,
common ownership or control. Also disclose any involvement that
the fundraising firm had in the selection of the entity listed in 6(b).
7. Campaign Manager and Contact Person
In response to 7(a), provide the name, telephone number, and email
address of the individual who is in charge of or the principal manager
of the campaign. If there is a different person our office should
contact with questions about the campaign or the notice, provide that
persons name, telephone number and email address in 7(b).
8. Bank Information
Enter the name of the bank and the account number into which the
contributions will be deposited. This information is required
regardless of which organization controls the account. Obtain this
information from the nonprofit beneficiary if the proceeds will be sent
directly to it from the contributors.
9. Attachments
Attach a copy of the fundraising contract and a written financial plan.
The plan shall provide a good-faith projection of the total revenue and
expenses for the solicitation campaign. It must specify whether the
campaign is directed toward new donor acquisitions, individual donor
renewals, or some combination thereof. The fundraising firm must
also deliver this plan to the nonprofit beneficiary prior to the start of
the campaign. If the fundraising firm engages in in-person or
telephone solicitations, attach a copy of the written disclosure that
will be used to comply with ORS 128.809 or 128.824. In addition,
provide a copy of the script or instructions given to solicitors to use in
connection with the oral disclosure requirements set forth in these
statutes. ORS 128.809 requires that in any in-person or telephone
solicitation, that the solicitor disclose that they are working under the
direction and control of the professional fundraising firm and a
similar disclosure must be delivered to the solicitee in writing within
10 days of the date of a solicitees pledge to contribute. ORS 128.824
requires commercial fundraising firms to make similar disclosures.
Signature
An authorized officer must sign in the space provided.
Amended Campaign Notices
The Department of Justice must be notified in writing of any change
in information contained in the current solicitation campaign notice
form on file. The written notification of change must be delivered
within 7 days after the change occurs. Firms may submit a new
solicitation campaign notice form indicating the changes, or the
changes may be listed in a letter.
Where to File
Submit the completed solicitation campaign notice form and all
required attachments to the following address:
Professional Fund-Raising Registrar
Charitable Activities Section
100 SW Market Street
Portland, Oregon 97201-5702
Alternatively, the completed and signed report can be emailed to
charitable@doj.state.or.us