Form 440-5353 "Intrastate Offering Final Sales Report" - Oregon

What Is Form 440-5353?

This is a legal form that was released by the Oregon Department of Consumer and Business Services - a government authority operating within Oregon. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2017;
  • The latest edition provided by the Oregon Department of Consumer and Business Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 440-5353 by clicking the link below or browse more documents and templates provided by the Oregon Department of Consumer and Business Services.

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Download Form 440-5353 "Intrastate Offering Final Sales Report" - Oregon

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Oregon Department of Consumer and Business Services
Division of Financial Regulation
350 Winter St. NE, Room 410, Salem, Oregon 97301-3881
Mailing address: P.O. Box 14480, Salem, OR 97309-0405
503-378-4140
Fax: 503-947-7862
http://dfcs.oregon.gov
OREGON INTRASTATE OFFERING FINAL SALES REPORT
ORS 59.035(15); OAR 441-035-0125
Issuers relying on the Oregon Intrastate Offering exemption must file a sales report with the director no later than
thirty (30) days after the expiration or termination of the offering. This form may be used to satisfy the requirement
in OAR 441-035-0125. All fields must be completed.
1. Name of the issuer:
Address of principal executive office of the issuer:
City:
State:
ZIP:
URL:
2. Name of contact person to receive notices
and communications regarding the offering:
Contact person’s phone number:
Contact person’s email address:
Contact person’s mailing address:
City:
State:
ZIP:
3. Oregon File Number:
4. Offering amount: $
5. Total amount raised through the offering: $
6. How many investors purchased securities through the offering?
6.a Attach on a separate sheet the names and contact information of the investors.
7. Were funds held in escrow or in a similar arrangement?
Yes
No
8. Have the funds been released?
Yes
No
Page 1
440-5353 (12/17/COM)
Oregon Department of Consumer and Business Services
Division of Financial Regulation
350 Winter St. NE, Room 410, Salem, Oregon 97301-3881
Mailing address: P.O. Box 14480, Salem, OR 97309-0405
503-378-4140
Fax: 503-947-7862
http://dfcs.oregon.gov
OREGON INTRASTATE OFFERING FINAL SALES REPORT
ORS 59.035(15); OAR 441-035-0125
Issuers relying on the Oregon Intrastate Offering exemption must file a sales report with the director no later than
thirty (30) days after the expiration or termination of the offering. This form may be used to satisfy the requirement
in OAR 441-035-0125. All fields must be completed.
1. Name of the issuer:
Address of principal executive office of the issuer:
City:
State:
ZIP:
URL:
2. Name of contact person to receive notices
and communications regarding the offering:
Contact person’s phone number:
Contact person’s email address:
Contact person’s mailing address:
City:
State:
ZIP:
3. Oregon File Number:
4. Offering amount: $
5. Total amount raised through the offering: $
6. How many investors purchased securities through the offering?
6.a Attach on a separate sheet the names and contact information of the investors.
7. Were funds held in escrow or in a similar arrangement?
Yes
No
8. Have the funds been released?
Yes
No
Page 1
440-5353 (12/17/COM)
Certification
I certify that I have made reasonable efforts to verify the accuracy and completeness of the information contained in
this form and the attached documents. I also affirm that I am aware of and will comply with all applicable
requirements under the Oregon Intrastate Offering Exemption, including the requirement that this form be amended
if there are any material changes to the form.
I am duly authorized by the issuer to sign this certification.
Signature:
Printed Name and Title:
Date:
ADDITIONAL INFORMATION
To properly file this form, the issuer must send this form to:
Department of Consumer and Business Services
Division of Financial Regulation
350 Winter Street NE, Rm. 410
Salem, OR 97301-3881
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440-5353 (12/17/COM)
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