Non-Refundable Processing Fee: [ ] Registration $32.00 [ ] Renewal $32.00
When renewing the collection agency, the bond date must match the collection agency’s registration date.
1. Registered business name: ____________________________________________________________________
2. Business street address: ______________________________________________________________________
Street Address
______________________________________________________________________
City State Zip
3. Date business formed or incorporated: ___________________________
4. Name of the principal applicant-owner of the agency or authorized officer of the corporation:
_________________________________________________________________________________________
5. Principal's Address: _________________________________________________________________________
Street Address
_________________________________________________________________________
City State Zip
6. All applications must include original surety bond written for 1 (one) year.
_____________________________________ _________________________
Signature of Applicant Date
Where to file: You may file in person or by m
ail. Means of payment are: cash, check, or money order. Non-
refundable processing fee of $32.00.
State of Utah
Department Of Commerce
Division of Corporations & Commercial Code
A
lication for Collection A
enc
Under GRAMA {63G-2-201}, all registration
information maintained by the Division is classified as public record. For confidentiality purposes,
you may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity.
*If
a collection agency is involved with collecting payments from consumer credit transactions, please contact
the Department of Financial Institutions at (801)538-8830 regarding requirements.
This form cannot be hand written.
Applicant must sign here after the form is printed
Mailing/Faxing Information:
www.corporations.utah.gov/contactus.html
www.corporations.utah.gov
