"Telemarketing Registration Statement Form" - Delaware

This "Telemarketing Registration Statement Form" is a document issued by the Delaware Department of Justice specifically for Delaware residents with its latest version released on June 25, 2002.

Download the up-to-date fillable PDF by clicking the link below or find it on the forms website of the Delaware Department of Justice.

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Download "Telemarketing Registration Statement Form" - Delaware

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State of Delaware
Department of Justice
Telemarketing Registration Statement
Section I. Information on the Registrant
Instructions. Please type or print the following information in the space provided. If necessary,
attach additional sheets that reference the appropriate section and sub-section.
Registrant’s True Name:
A.
Registrant’s Current Address:
B.
Address (Line 1)
Address (Line 2)
City, State, Zip Code
Registrant’s Telephone Number:
C.
(
) _____ - _______
Registrant’s Principle Place of Business:
D.
Address (Line 1)
Address (Line 2)
City, State, Zip Code
E.
Each Fictitious or Business Name under which the Registrant Intends to Engage In
Telemarketing:
Fictitious/Business Name # 1
Fictitious/Business Name # 2
Fictitious/Business Name # 3
Fictitious/Business Name # 4
Fictitious/Business Name # 5
1
State of Delaware
Department of Justice
Telemarketing Registration Statement
Section I. Information on the Registrant
Instructions. Please type or print the following information in the space provided. If necessary,
attach additional sheets that reference the appropriate section and sub-section.
Registrant’s True Name:
A.
Registrant’s Current Address:
B.
Address (Line 1)
Address (Line 2)
City, State, Zip Code
Registrant’s Telephone Number:
C.
(
) _____ - _______
Registrant’s Principle Place of Business:
D.
Address (Line 1)
Address (Line 2)
City, State, Zip Code
E.
Each Fictitious or Business Name under which the Registrant Intends to Engage In
Telemarketing:
Fictitious/Business Name # 1
Fictitious/Business Name # 2
Fictitious/Business Name # 3
Fictitious/Business Name # 4
Fictitious/Business Name # 5
1
State of Delaware
Department of Justice
Telemarketing Registration Statement
Section II. Registrant’s Prior Business History
Instructions. Please type or print all occupations and businesses that the Registrant has engaged in
for the two years immediately preceding the date of registration. If necessary, attach additional
sheets that reference this section.
2
State of Delaware
Department of Justice
Telemarketing Registration Statement
Section III. Criminal History
Instructions. Please indicate whether any of the following persons have been convicted of, or pled
guilty to, or is being prosecuted in any jurisdiction for racketeering, violation of state or federal
securities laws, theft, fraud, forgery or any other offenses involving falsehood or deception by
circling either yes or no below:
1. The Registrant;
2. The Registrant’s owners if the Registrant is not a natural person;
3. Any person employed by the Registrant as a telemarketer;
4. Any person employed by the Registrant as a manager;
5. Any person employed by the Registrant as a director.
Yes
No
If you have circled yes, please complete and attach the enclosed Criminal History Form for each
conviction, guilty plea, or current prosecution. If necessary, make additional copies of the Criminal
History Form.
Section IV. Civil and Administrative Action History
Instructions. Please indicate whether any of the following persons have been subject to any
pending or final cease and desist order, assurance of discontinuance, injunction, restraining order or
judgment under Chapters 25 or 25A of Title 6 of the Delaware Code or in any other civil or
administrative action in any other jurisdiction, involving telemarketing, consumer or securities fraud,
deceptive trade practices, racketeering or any other civil enforcement statute involving fraud or
deception by circling either yes or no below:
1. The Registrant;
2. The Registrant’s owners if the Registrant is not a natural person;
3. Any person employed by the Registrant as a telemarketer;
4. Any person employed by the Registrant as a manager; or
5. Any person employed by the Registrant as a director.
Yes
No
If you have circled yes, please complete and attach the enclosed Civil and Administrative Action
History Form for each pending or final cease and desist order, assurance of discontinuance,
injunction, restraining order or judgment. If necessary, make additional copies of the Civil and
3
State of Delaware
Department of Justice
Telemarketing Registration Statement
Administrative Action History Form.
Section V. Bankruptcy History
Instructions. Please indicate whether any of the following persons within the previous seven years
has filed for bankruptcy, been adjudged bankrupt or been reorganized because of insolvency by
circling either yes or no below:
1. The Registrant; or
2. The Registrant’s owners or directors if the Registrant is not a natural person.
Yes
No
If you have circled yes, please complete and attach the enclosed Bankruptcy History Form for
each bankruptcy filing, adjudication or reorganization. If necessary, make additional copies of the
Bankruptcy History Form.
Section VI. Identification of Telemarketing Business Hired by Seller
Instructions. Please indicate whether the Registrant is a “seller.” A “seller” utilizes telemarketing
or engages the services of a telemarketing business to promote, advertise, sell or distribute
merchandise by circling either yes or no below:
Yes
No
If you have circled yes, please complete and attach the enclosed Telemarketing Business
Identification Form for each telemarketing business hired by the Registrant for telemarketing to
customers located in the State of Delaware.
If necessary, make additional copies of the
Telemarketing Business Identification Form.
Section VII. Identification of Seller’s that Have Hired the Registrant
Instructions. Please indicate whether the Registrant is a “telemarketing business” by circling either
yes or no below. A “telemarketing business” engages in telemarketing on behalf of any seller in
exchange for any consideration or compensation.
Yes
No
If you have circled yes, please complete and attach the enclosed Seller Identification Form for
4
State of Delaware
Department of Justice
Telemarketing Registration Statement
each seller that has hired the Registrant to engage in telemarketing to customers located in the State
of Delaware. If necessary, make additional copies of the Seller Identification Form.
Section VIII.
Employee Information
Instructions. Please complete and attach the enclosed Employee Information Form for each
owner and director of the Registrant, telemarketer employed by the Registrant and person
participating in or responsible for the management of the telemarketing business or telemarketing
activities of the Registrant. If necessary make additional copies of the Employee Information Form.
Section IX. Financial Institution Information
Instructions. Please indicate the name and address of every financial institution where proceeds of
the Registrants telemarketing sales are to be deposited. If necessary, attach additional sheets that
reference this section.
Financial Institutions’s Name
Address Line # 1
Address Line # 2
City, State, Zip
Financial Institutions’s Name
Address Line # 1
Address Line # 2
City, State, Zip
5
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