COLORADO UNIFORM CONSUMER CREDIT CODE
2019 RETAIL SALES (SELLERS/LESSORS) INITIAL NOTIFICATION FORM
WEBSITE: WWW.COAG.GOV/UCCC EMAIL: UCCC@COAG.GOV TELEPHONE: 720-508-6012
YOU MUST COMPLETE ALL SECTIONS AND FORMS.
IF A SECTION DOES NOT APPLY, PLEASE WRITE N/A. ENCLOSE CHECK PAYMENT WITH SUBMISSION.
COLORADO DEPARTMENT OF LAW
UNIFORM CONSUMER CREDIT CODE
RALPH L. CARR COLORADO JUDICIAL CENTER
1300 BROADWAY, 6
TH
FLOOR
DENVER, CO 80203
MAKE CHECKS PAYABLE TO: COLORADO
UNIFORM CONSUMER CREDIT CODE OR
COLORADO UCCC
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2. ALL TRADE NAMES IN WHICH BUSINESS IS TRANSACTED:
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3. PHYSICAL ADDRESS OF PRINCIPAL OFFICE (MAY BE OUTSIDE COLORADO):
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4. DO YOU HAVE ANY ADDITIONAL LOCATION(S) WHERE CONSUMER CREDIT SALES/LEASES ARE MADE?
(CIRCLE ONE) YES OR NO
IF YES, YOU MUST COMPLETE THE ENCLOSED LIST OF LOCATIONS
5. ARE CONSUMER CREDIT SALES OR CONSUMER LEASES MADE OTHER THAN AT AN OFFICE/RETAIL STORE/LOCATION?
(CIRCLE ONE) YES OR NO IF YES, HOW? ___ MAIL ___ INTERNET ___ OTHER ___ _____________________
6. DATE IN WHICH CONSUMER CREDIT TRANSACTIONS COMMENCED IN COLORADO:
7. TOTAL # OF CREDIT SALES IN 2018 (INCLUDES ASSIGNMENT) ________________ TOTAL VOLUME $ __________________
8. DO YOU COLLECT PAYMENTS ON THE CONTRACTS YOU ORIGINATE? (CIRCLE ONE) YES OR NO
9. DO YOU ONLY ENGAGE IN CONSUMER CREDIT SALES (EXTENSION OF CREDIT AS PART OF THE PURCHASE OR LEASE OF GOODS,
SERVICES, A MOBILE HOME, OR AN INTEREST IN LAND) AS OPPOSED TO MAKING, SERVICING, OR TAKING ASSIGNMENT OF
SUPERVISED LOANS (DIRECT LOANS TO CONSUMERS IN EXCESS OF 12% APR)? (CIRCLE ONE) YES OR NO
IF YOU ANSWER “NO”—MEANING THAT YOU ARE ALSO MAKING, SERVICING, OR TAKING ASSIGNMENT OF SUPERVISED LOANS—
YOU MUST OBTAIN A SUPERVISED LENDER’S LICENSE.
10. NAME & ADDRESS OF COLORADO REGISTERED AGENT UPON WHOM SERVICE OF PROCESS MAY BE MADE:
2. LATE FEE* (IF APPLICABLE)
*NOTIFICATIONS FILED AFTER 30 DAYS OF COMMENCING BUSINESS MUST INCLUDE A STATUTORY LATE FEE OF $5.00 PER
CALENDAR DAY IMPOSED STARTING THE 31
ST
THE UNDERSIGNED HEREBY FILES NOTIFICATION OF INTENT TO ENGAGE IN MAKING OR COLLECTING OR ENFORCING RIGHTS UNDER
COLORADO CONSUMER CREDIT SALES AND/OR CONSUMER LEASES.
I HEREBY VERIFY THAT THE INFORMATION STATED ABOVE AND THE AMOUNT PAID ARE TRUE AND CORRECT.
X_____________________________________________________
SIGNATURE OF OWNER/OFFICER/PARTNER
_____________________________________________________
PRINTED NAME OF OWNER/OFFICER/PARTNER
MANDATORY INFORMATION FOR SOLE PROPRIETORS AND INDIVIDUAL REGISTRANTS (NOT OPEN TO PUBLIC INSPECTION). THIS INFORMATION IS REQUIRED
BY §§ 14-14-113 AND 24-31-107, C.R.S. AND MAY BE USED TO REVOKE, SUSPEND, OR DENY LICENSES OR NOTIFICATIONS AS DETERMINED BY THE STATE CHILD
SUPPORT ENFORCEMENT AGENCY FOR NONCOMPLIANCE WITH SUPPORT ORDERS OR SUBPOENAS/WARRANTS RELATING TO PATERNITY AND CHILD SUPPORT.
ALSO INCLUDE A PHOTOCOPY OF YOUR DRIVER’S LICENSE, STATE IDENTIFICATION CARD, OR OTHER PHOTO IDENTIFICATION.
COMPLETE HOME ADDRESS: ___________________________________________________________________ ________ SSN: _______________________
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