Fillable State of Illinois Credit Services Organization Registration Statement (Illinois Secretary of State)

Fill Online, Printable, Fillable, Blank State of Illinois Credit Services Organization Registration Statement (Illinois Secretary of State) Form

Use Fill to complete blank online ILLINOIS SECRETARY OF STATE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

State of Illinois Credit Services Organization Registration Statement (Illinois Secretary of State)

On average this form takes 6 minutes to complete

The State of Illinois Credit Services Organization Registration Statement (Illinois Secretary of State) form is 2 pages long and contains:

  • 0 signatures
  • 2 check-boxes
  • 23 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Illinois Secretary of State forms online.

BROWSE ILLINOIS SECRETARY OF STATE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
State of Illinois
Credit Services Organization Registration Statement
Required by Public Act 85-1384, effective Jan. 1, 1989, 815 ILCS 605/9 — $100 Filing Fee
Secretary of State Index Department
111 E. Monroe
Springfield, IL 62756
217-782-7017
www.cyberdriveillinois.com
When a change in the information contained in this statement occurs, the credit services organization is required to file an amended
statement within 90 days. There is no fee for filing amended statements.
A credit services organization is required to continuously maintain a $100,000 surety bond if that organization charges or receives
any money or other valuable consideration prior to full and complete performance of the services the organization has agreed to
perform. A bond also shall be maintained for two years after the date the organization ceases operations.
A file-stamped copy of this statement will be returned to the credit services organization who must maintain the copy in their files
and allow a buyer to inspect the registration statement.
1. Name and Address of the Credit Services Organization:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
2. Name and Address of the Registered Agent of Individual Authorized to Accept Service of Process on Behalf of the Credit Services
Organization:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
3. Name and Address of All Persons Who Directly or Indirectly Own or Control 10 Percent or More of the
Outstanding Shares of Stock in the Credit Services Organization: (If more space is needed, attach additional sheets of this size.)
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
4. If any, the Bond Number, Name and Location of the Surety Company Issuing a $100,000 Surety Bond as Required by the Credit
Services Organizations Act:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Printed by authority of the State of Illinois - December 2009 - 50 - I 220
Print
Reset
5. (A) Has there been any litigation or unresolved complaint filed with a governmental authority of this state, any other state or the
United States relating to the operation of this Credit Services Organization?
r
Yes — If yes, attach a full disclosure.
r No
(B) If there has been no litigation or unresolved complaint filed, the statement must be completed and notarized.
I, ____________________________________________________________________, ______________________________________
of ___________________________________________________________________________________________________________
do hereby affirm that there has been no litigation or unresolved complaint filed with a governmental authority of this state, any
other state or the United States relating to the operation of this Credit Services Organization.
______________________________________________________________________________
Subscribed and affirmed before me on ___________________________, __________________
________________________________________________
6. I do hereby affirm that the foregoing statements and any attachments are true and correct.
________________________________________________
________________________________________________
Subscribed and affirmed before me on ___________________________, __________________
________________________________________________
Name
Signature
Signature of Notary Public
Signature of Notary Public
Signature
Official Capacity
Seal
Seal
Name of Credit Services Organization
Official Capacity
Printed by authority of the State of Illinois. December 2009 — 50 — I 220
Return completed form and $100 filing fee to:
Secretary of State, Index Department, 111 E. Monroe, Springfield, IL 62756 • 217-782-7017
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

State of Illinois Credit Services Organization Registration Statement (Illinois Secretary of State)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 28 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document