1. a) the name, business address and telephone number of the issuer, and as applicable, of the controlling person and dealer;
2. b) a description of the securities sold to residents of this State; and
3. c) the date of the initial sale of securities to residents of this State for this reporting period;

The Report of Sale of securities sold in this State in reliance upon Section 4.G of the Act shall contain, without limitation, the following:

(Source: Amended at 21 Ill. Reg. 15892, effective December 1, 1997)