Form D
View Original Filing
Notice of Exempt Offering of Securities
Item 1. Issuer's Identity
Name of Issuer:
AVALARA INC
Jurisdiction of Incorporation/Organization
WA
Year of Incorporation/Organization
Over Five Years Ago
Item 2 Issuer Principal Place of Business and Contact Information
435 ERICKSEN AVE NE
STE 250
BAINBRIDGE ISLAND, WA 98110
Phone Number:
subscription required
Item 3. Related Persons
Name
SCOTT MCFARLANE
Address
subscription required
Relationship(s)
- EXECUTIVE OFFICER
- DIRECTOR
Clarification of Response
Item 3. Related Persons
Name
JARED VOGT
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
JOHN CARLETON
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
GARY WATERMAN
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
SCOTT STEIGERWALD
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
BEN GOUX
Address
subscription required
Relationship(s)
Clarification of Response
Item 4. Industry Group
OTHER TECHNOLOGY
Item 5. Issuer Size
Revenue Range (for issuer not specifying "hedge" or "other investment" fund in Item 4 above)
DECLINE TO DISCLOSE
Item 6. Federal Exemptions and Exclusions Claimed
Item 7. Type of Filing
New Notice
Date of First Sale in this Offering:
01/21/2010
Item 8. Duration of Offering
Does the issuer intend this offering to last more than one year?
No
Item 9. Type(s) of Securities Offered
Item 10. Business Combination Transaction
Is this offering being made in connection with a business combination
transaction, such as a merger, acquisition or exchange offer?
Yes
Clarification of Response
SHARE EXCHANGE IN CONJUNCTION WITH A MERGER.
Item 11. Minimum Investment
Minimum Investment accepted from any outside investor
1
Item 13. Offering and Sales Amounts
Total Offering Amount
5000000
Total Amount Sold
5000000
Total Remaining to be Sold
0
Clarification of Response
SHARE EXCHANGE IN CONJUNCTION WITH A MERGER.
Item 14. Investors
Securities in the offering have been or may be sold to persons
who do not qualify as accredited investors,
Yes
Number of non-accredited investors who already have invested in the offering:
7
Total number of investors who already have invested in the offering:
30
Item 15. Sales Commissions and Finders' Fees Expenses
Sales Commissions:
0.0
Finders' Fees
0.0
Clarification of Response
Item 16. Use of Proceeds
Provide the amount of the gross proceeds of the offering
that has been or is proposed to be used for payments to any of the persons required
to be named as executive officers,directors or promoters in response to Item 3 above.
0.0
Clarification of Response
SHARE EXCHANGE IN CONJUNCTION WITH A MERGER.
Signature and Submission
Issuer Name
AVALARA INC
Issuer Signature
/S/ DAREN NITZ
Signer Name
DAREN NITZ
Signer Title
ASSISTANT SECRETARY
Signature Date
01/28/2010
