CHECKLIST AND INSTRUCTIONS FOR
CREDIT ACCESS BUSINESS REGISTRATION
Please be sure to completely read all instructions before preparing your registration application.
Texas State Statute Chapter 393 requires credit access businesses, payday lenders and auto title
lenders, to obtain a state issued license before conducting business in the state. The City of Bedford
Ordinance No. 2016-3183 provides for the oversight of payday and auto title lending transactions in
the City of Bedford. The ordinance requires that each lender location licensed under Chapter 393,
register as well with the City of Bedford. The annual registration fee for each credit access business
location is $25 and is nonrefundable. The registration fee must be submitted at the time of
application. Any credit access business not in compliance with the City of Bedford Ordinance No.
2016-3183 may be subject to criminal penalties up to $500 per occurrence. A certificate of
registration for a credit access business is not transferable. Please allow 30 days for processing
once a complete application is received.
To apply for an initial permit:
Complete a Credit Access Business Registration application form for each credit access business
location that
is operating within the City of Bedford. The $25 registration must be submitted with
the application.
All information in the application form is required. Incomplete applications cannot be
processed.
Payments can be submitted in person or by mail to the address below. Forms of payment
accepted are cash, check, Visa or Mastercard only.
To submit a complete credit access business registration application, the information listed
below must be enclosed with the application:
Copy of Texas state li
cense issued under Chapter 393 of Texas Finance Code.
Copy of Certificate of
Occupancy issued by the City of Bedford.
Submit completed registration application and registration fee to:
City of Bedford
Permits & Inspections Dept.
2000 Forest Ridge Dr. - Building B
Bedford, TX 76021
To renew (annually) an ex
isting permit:
Complete a Credit Access Business Registration Form. As per City ordinance 2016-3183, a credit
access business cannot operate or conduct business without a certificate of registration issued by the
City of Bedford. Registration is required for each location operating or conducting business. The credit
access business must submit an annual application to renew the registration and pay a nonrefundable
$25 fee. All registration renewals and payments are to be mailed to the City of Bedford at the address
provided.
All information in the application form is required. Incomplete applications cannot be
processed. Submit completed registration renewal application and documents, as
specified, no less than 30 calendar days before one year after the date of issuance.
Forms required for
annual registration renewal:
A complete Credit Access Business Registration Form for each renewal application.
A copy of the license issued by the State of Texas, under Chapter 393 of Texas Finance Code.
Additional information related to City of Bedford registration application:
State CAB license number is the location specific license number, provided by the Texas Office of
Consumer Credit Commissioner.
CAB Registration number will be assigned by the City of Bedford
with the initial registration and
should be entered by the CAB applicant/registrant during the application renewal process.
Contact Person is the designee as indicated in the registration application, and is the person who will
be contacted by phone or email, if there are questions related to the CAB registration process/
application.
Owners and Principle Parties include all persons with a financia
l interest in the credit access
business: complete contact information regarding owners and principle parties.
Registered agent of service of process in Texas for any/all publicly traded companies that are
operating and/or conducting business in the City of Bedford.
Date is the date that applicant/registrant submits application for CAB registration.
CREDIT ACCESS BUSINESS REGISTRATION
Registration Fee: $25 (non-refundable)
CAB Application Form
Page 1 of 2
Date of Filing:
(If Renewing)
COSA Registration
Number:
SECTION 1: Exact name, main office address, mailing address, and telephone number of applicant
Business Entity Name Federa
l
Emp
loyment Ident
if
ic
a
t
ion Number (FEIN)
Operating Name of Business (d/b/a)
Location Address:
Number & Street Name
City State Zip
Mailing Address:
State Zip
Number & Street Name
Location
Phone
Number:
City
Location FAX Number:
Website:
SECTION 2: Contact information for main office
Contact person for this application:
Name & Title Business Phone FAX Number
Email Address
Person Responsible for day-to-day operations:
Name & Title Business Phone FAX Number
Email Address
Phone: (817) 952-2140
Fax: (817) 952-2210
State CAB License Number:
CAB Application Form Page 2 of 2
SECTION 3: Owner contact information
Owners: Proprietors, Partners, Members or Stockholders having any financial interest. Information from each owner is
required. Please attach pages if additional space is required.
1. Name:
Financial Interest:
Street Address:
Number & Street Name City State Zip
Mailing Address:
Number & Street Name City State Zip
Telephone: Email:
2. Name:
Financial Interest:
Street Address:
Number & Street Name City State Zip
Mailing Address:
Number & Street Name City State Zip
Telephone: Email:
Publicly Traded Company - Registered Agent (Individual to whom any legal notice may be delivered):
Agent Name:
Agent Address:
Number & Street Name City State Zip
Agent Phone Number: Agent Fax Number:
SECTION 4: Additional documents required
Attachments Required
Copy of Texas state license issued under Chapter 393 of Texas Finance Code.
Copy of current, valid Certificate of Occupancy showing the business is in compliance with the Code
of Ordinance of the City of Bedford.
This is an application to secure a Certificate of Registration to operate a credit access ("payday lending") business,
per City of Bedford Ordinance No. 2016-3183. Registration with the City of Bedford is a requirement of credit
access business and each location operated as a credit access business must be registered. The undersigned
affirms that all information provided in this application for registration, including but not limited to, disclosure of
owners, principal parties, and all other supporting documents, schedules and exhibits are true, complete and free
from any material omissions. The undersigned understands that the information provided may be further verified.
The undersigned further understands that FALSE OR MATERIALLY INCOMPLETE RESPONSES ARE GROUNDS FOR
DENIAL OF THE APPLICATION TO REGISTER AS A CREDIT ACCESS BUSINESS WITH THE CITY OF BEDFORD.
Signature Title Date
CREDIT ACCESS BUSINESS REGISTRATION (cont.)
click to sign
signature
click to edit
CONSUMER CREDIT INFORMATION
THIS IS FOR INFORMATIONAL PURPOSES ONLY AND IS NOT INTENDED TO BE AN
ENDORSEMENT OF ANY PROGRAM OR ENTITY.
Education and Training
OFFICE OF THE CONSUMER CREDIT COMMISSIONER / CONSUMER HELPLINE
Phone: (800) 538-1579
http://www.occc.state.tx.us/pages/consumer/Index.html
NA
TIONAL ENDOWMENT FOR FINANCIAL EDUCATION (NEFE)
http://www.nefe.org/
US
DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (HUD)
http://portal.hud.gov/hudportal/HUD
TEXAS ATTORNEY GENERAL / CONSUMER PROTECTION DIVISION
DALLAS REGIONAL OFFICE
Phone: (214) 969-7639
Address: 1412 Main Street, Suite 810, Dallas, TX 75202
https://texasattorneygeneral.gov/cpd/consumer-protection
AMERICAN INSTITUTE OF CERTIFIED PUBLIC ACCOUNTANTS (AICPA)
http://www.feedthepig.org/
MY MONEY
http://www.mymoney.gov/
CONSUMER CREDIT COUNSELING SERVICE OF GREATER DALLAS
Phone: (972) 255-0079
Address: 4322 N. Beltline Road
www.cccs.net
RAMOS LAW FIRM CONSUMER CREDIT REPAIR ATTORNEY
Phone: (214) 556-2300
Address: 2704 Valley View Lane, Dallas, TX 75234
https://txclf.com/
TARRANT COUNTY HOUSING PARTNERSHIP, INC.
http://www.tchp.net/resources/resources.html
FINANCIAL ASSISTANCE RESOURCES
2-1-1 TEXAS
Phone: 211
http://www.211texas.org/
CATHOLIC CHARITIES OF FORT WORTH
Phone: (817) 274-2560
Address: 917 W Sanford St, Arlington, TX 76012
https://www.catholiccharitiesfortworth.org/
CHRISTIAN CONNECTION ST. MICHAEL CATHOLIC CHURCH
Phone: (817) 283-8746
Address: 3713 Harwood Road, Bedford, TX 76021
http://smcchurch.org/christian-connfinan-assistjob-fair
F
INANCIAL HELP RESOURCES
http://www.financialhelpresources.com/
TARRANT COUNTY ASSISTANCE PROGRAMS
http://www.needhelppayingbills.com/html/tarrant_county_assistance_prog.html
COMMUNITY ACTION PARTNERS CITY OF FORT WORTH
Phone: (817) 392-5780
Address: 4200 South Fwy #2310, Fort Worth, TX 76115
http://fortworthtexas.gov/cap/
TEXAS HEALTH RESOURCES FINANCIAL ASSISTANCE
Phone: (877) 847-9355
https://www.texashealth.org/pages/patient-and-visitor-information/billing-and-payment-
information/financial-help-for-those-in-need.aspx
HOMEBASE FOR HOUSING
Phone: (866) 863-1626
Address: 4054 McKinney Ave, Suite 102, Dallas, TX 75204
http://homebaseforhousing.org/Default.cshtml
Información al Consumidor Tocante Asuntos de Crédito
Este formulario es sólo para fines informativos y no pretende ser una aprobación de
cualquier programa o entidad.
Educación y Capacitación
OFFICE OF THE CONSUMER CREDIT COMMISSIONER / CONSUMER HELPLINE
Phone: (800) 538-1579
http://www.occc.state.tx.us/pages/consumer/Index.html
NA
TIONAL ENDOWMENT FOR FINANCIAL EDUCATION (NEFE)
http://www.nefe.org/
US
DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (HUD)
http://portal.hud.gov/hudportal/HUD
TEXAS ATTORNEY GENERAL / CONSUMER PROTECTION DIVISION
DALLAS REGIONAL OFFICE
Phone: (214) 969-7639
Address: 1412 Main Street, Suite 810, Dallas, TX 75202
https://texasattorneygeneral.gov/cpd/consumer-protection
AMERICAN INSTITUTE OF CERTIFIED PUBLIC ACCOUNTANTS (AICPA)
http://www.feedthepig.org/
MY MONEY
http://www.mymoney.gov/
CO
NSUMER CREDIT COUNSELING SERVICE OF GREATER DALLAS
Phone: (972) 255-0079
Address: 4322 N. Beltline Road
www.cccs.net
RAMOS LAW FIRM CONSUMER CREDIT REPAIR ATTORNEY
Phone: (214) 556-2300
Address: 2704 Valley View Lane, Dallas, TX 75234
https://txclf.com/
TARRANT COUNTY HOUSING PARTNERSHIP, INC.
http://www.tchp.net/resources/resources.html
Recursos de asistencia financier
2-1-1 TEXAS
Phone: 211
http://www.211texas.org/
CATHOLIC CHARITIES OF FORT WORTH
Phone: (817) 274-2560
Address: 917 W Sanford St, Arlington, TX 76012
https://www.catholiccharitiesfortworth.org/
CHRISTIAN CONNECTION ST. MICHAEL CATHOLIC CHURCH
Phone: (817) 283-8746
Address: 3713 Harwood Road, Bedford, TX 76021
http://smcchurch.org/christian-connfinan-assistjob-fair
F
INANCIAL HELP RESOURCES
http://www.financialhelpresources.com/
TARRANT COUNTY ASSISTANCE PROGRAMS
http://www.needhelppayingbills.com/html/tarrant_county_assistance_prog.html
COMMUNITY ACTION PARTNERS CITY OF FORT WORTH
Phone: (817) 392-5780
Address: 4200 South Fwy #2310, Fort Worth, TX 76115
http://fortworthtexas.gov/cap/
TEXAS HEALTH RESOURCES FINANCIAL ASSISTANCE
Phone: (877) 847-9355
https://www.texashealth.org/pages/patient-and-visitor-information/billing-and-payment-
information/financial-help-for-those-in-need.aspx
HOMEBASE FOR HOUSING
Phone: (866) 863-1626
Address: 4054 McKinney Ave, Suite 102, Dallas, TX 75204
http://homebaseforhousing.org/Default.cshtml
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