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2801 OFFICE OF THE SECRETARY OF STATE

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Form 2801
Form 2801—General Information
(Credit Services Organization Registration Statement)
The attached form is designed to meet minimal statutory filing requirements pursuant to the relevant code
provisions. This form and the information provided are not substitutes for the advice and services of an
attorney.
Commentary
Credit Services Organizations (“CSOs”) are governed by chapter 393 of the Texas Finance Code and the
secretary of state’s administrative rules found in title 1, chapter 74 of the Texas Administrative Code.
Section 393.101 sets forth the requirements for a CSO’s registration statement.
Registration statements are effective the date the completed registration statement and filing fee are
received by the secretary of state. The registration expires one year from the date of issuance and may be
renewed.
This form is for both new registrations and renewals. Any change to the information given on the
registration statement must be filed with the secretary of state within 90 days of the change.
Instructions for Form
Preliminary Information: Select the appropriate box indicating whether this is a new
registration or renewal. If it is a renewal, you should provide the registration number assigned by
the secretary of state to facilitate processing of the document.
CSO Information: The registration statement must set forth the CSO’s name and address. To
facilitate filing of the registration statement, you should also include the CSO’s telephone
number.
Owner Information: If the CSO is a corporation or limited liability company, the registration
statement must provide the name and address of any person who directly or indirectly owns or
controls 10% or more of ownership interest of the entity. If the CSO has more than three owners,
use an additional sheet.
A document on file with the secretary of state is a public record subject to public access and
disclosure. When providing address information for owners, use a business or post office
box address rather than a residence address if privacy concerns are an issue.
Statement Regarding Security: With new registrations, select “A” or “B,” whichever is
appropriate to indicate whether proof of security is attached or not required. If proof of security
is not required, explain why. With renewals, select “A” or “B” and follow the same steps or, if
applicable, select “C” or “D”, whichever is appropriate to indicate that the security is the same as
provided before with no changes or that a rider reflecting changes is attached.
Litigation Disclosure: The registration statement must disclose all litigation and/or complaints
filed with a Texas governmental authority relating to the operation of the credit services
organization. If no such litigation or complaint is pending or has been completed, the application
must contain a sworn statement to that effect.
1
Form 2801 2
Attachments: The following items must be included with the application:
For New Registrations
1. Proof of security or a statement explaining why proof of security is not required; and
2. Filing fee of $100.
For Renewals
1. Proof of new security, continued security, or a rider reflecting any updates to existing
security, or a statement explaining why proof of security is not required; and
2. Filing fee of $100.
Execution: If the application contains a statement that no litigation and/or complaint is pending
or was filed against the CSO, a person authorized to sign on behalf of the CSO must sign and
date the registration statement before a notary public or other official who has authority to
administer an oath. Otherwise, although the document must still be executed by an authorized
person, execution before an individual authorized to administer an oath is not required.
Payment and Delivery Instructions: The filing fee for a CSO registration statement or renewal
is $100. Fees may be paid by personal checks, money orders, LegalEase, debit cards or
American Express, Discover, MasterCard, and Visa credit cards. Checks or money orders must
be payable through a U.S. bank or financial institution and made payable to the secretary of state.
Fees paid by credit card are subject to a statutorily authorized convenience fee of 2.7 percent of
the total fees.
The completed form, along with the filing fee and proof of security, may be mailed to
Registrations Unit, P.O. Box 13550, Austin, Texas 78711-3550 or delivered to the James Earl
Rudder Office Building, 1019 Brazos, 5
th
Floor, Austin, Texas 78701. The secretary of state will
issue a certificate of registration upon filing of a completed application.
Revised 08/2014
This space reserved for office use
Form 2801
Form #2801 Rev. 08/2014
Submit to:
SECRETARY OF STATE
Registrations Unit
P O Box 13550
Austin, TX 78711-3550
512-475-0775
512-475-2815 - Fax
Filing Fee: $100
REGISTRATION STATEMENT
FOR A CREDIT SERVICES
ORGANIZATION
Application for New Registration
Application for Renewal of Registration
Registration Number:
Credit Services Organization Information
Name: Phone:
Street City State Zip
Additional Locations
Address:
Street City State Zip
Address:
Street City State Zip
Address:
Street City State Zip
Owner Information
If corporation or LLC, list each person who directly or indirectly owns or controls 10% or more of the governing interest.
Name:
Mailing Address:
Street City State Zip
Name:
Mailing Address:
Street City State Zip
Name:
Mailing Address:
Street City State Zip
LIST ANY OTHER LOCATIONS AND/OR OWNERS ON A SEPARATE SHEET
3
Form 2801
Statement Regarding Security
Complete one of the following:
A. A copy of the surety bond or statement from an authorized depository certifying the establishment
and amount of a surety account for each location is attached.
OR
B. The security requirement of section 393.302, Finance Code is not applicable because:
(Applicable to Renewals only):
C. This is an application for renewal. The copy of the security previously provided for each location
is valid and has not expired. No information on the copy of the security previously provided for each
location has changed.
OR
D. This is an application for renewal. A rider (or riders) from the surety company is (are) attached
reflecting updates to the information on the face of the bond (or bonds).
Litigation Disclosure
Complete one of the following:
A. There has been no litigation or unresolved complaint filed with a Texas governmental authority
relating to the operation of the credit services organization named above.
(If option A is selected, execute this document before a notary public or other officer authorized to administer an oath.)
OR
B. Litigation and/or complaint(s) filed with a Texas governmental authority relating to the operation
of the above-named credit services organization are currently pending or have been completed and are
described below:
Attachments
The following items are included with this application:
1. Proof of security, if required (for renewals, see above); and
2. $100 filing fee.
Execution
Date:
Signature of Authorized Person for Credit Services Organization
Printed or typed name of Authorized Person for Credit Services Organization
State of
)
County of )
Sworn to and subscribed before me this day of , 20 .
(seal)
Notary Public Signature
4
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Completed 2 July 2020

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