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TELEPHONE: 720-508-6012 YOU MUST COMPLETE ALL SECTIONS AND (Colorado Dept. of Law)

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COLORADO UNIFORM CONSUMER CREDIT CODE
2017 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.
RETURN TO:
COLORADO DEPARTMENT OF LAW
UNIFORM CONSUMER CREDIT CODE
RALPH L. CARR COLORADO JUDICIAL CENTER
1300 BROADWAY, 6TH FLOOR
DENVER, CO 80203
MAKE CHECKS PAYABLE TO:
COLORADO UNIFORM CONSUMER CREDIT CODE
OR COLORADO UCCC
COMPLETE THE FOLLOWING:
1. LEGAL NAME:
2. ALL TRADE NAMES IN WHICH BUSINESS IS TRANSACTED:
3. PHYSICAL ADDRESS OF PRINCIPAL OFFICE (MAY BE OUTSIDE OF COLORADO):
4. DO YOU HAVE ANY ADDITIONAL LOCATIONS 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/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 NUMBER OF CREDIT SALES IN 2016 __________________ TOTAL VOLUME $ __________________________
8. DO YOU COLLECT PAYMENTS ON THE CONTRACTS YOU ORIGINATE? (CIRCLE ONE) YES OR NO
9. SUPERVISED LOANS ARE DIRECT CONSUMER LOANS IN EXCESS OF 12% APR. DO YOU MAKE, SERVICE, OR TAKE
ASSIGNMENT OF SUPERVISED LOANS? (CIRCLE ONE) YES
OR NO IF YES, YOU MUST OBTAIN A SUPERVISED LENDER’S LICENSE
10. NAME & ADDRESS OF COLORADO REGISTERED AGENT UPON WHOM SERVICE OF PROCESS MAY BE MADE:
FEE SCHEDULE
1. NOTIFICATION FEE
$ ___________ 130.00
2. LATE FEE* (IF APPLICABLE)
$ _________________
3. TOTAL FEES DUE
$ _________________
*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
DAY OF BUSINESS.
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
DATE
_____________________________________________________
___________________
PRINTED NAME OF OWNER/OFFICER/PARTNER
TELEPHONE NUMBER
MANDATORY INFORMATION FOR SOLE PROPRIETORS (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: _______________________
2017 LIST OF ASSIGNEES/SERVICERS
Colorado Uniform Consumer Credit Code
IF YOU SELL OR ASSIGN CONSUMER CREDIT SALES AND LEASES TO FINANCE COMPANIES OR BANKS, YOU MUST
COMPLETE THE FORM PROVIDED BELOW.
LIST THE NAME AND COMPLETE MAILING ADDRESS OF EACH COMPANY THAT PURCHASES OR TAKES ASSIGNMENT OF
YOUR CONSUMER CREDIT SALES AND LEASES. ATTACH ADDITIONAL SHEETS IF NECESSARY.
NAME OF ASSIGNEE(S)/SERVICER(S)
MAILING ADDRESS(ES)
________________________________________________________
Address
________________________________________________________
City State Zip Code
________________________________________________________
Address
________________________________________________________
City State Zip Code
________________________________________________________
Address
________________________________________________________
City State Zip Code
________________________________________________________
Address
________________________________________________________
City State Zip Code
________________________________________________________
Address
________________________________________________________
City State Zip Code
________________________________________________________
Address
________________________________________________________
City State Zip Code
________________________________________________________
Address
________________________________________________________
City State Zip Code
2017 LIST OF LOCATIONS
Colorado Uniform Consumer Credit Code
LIST ALL OFFICES, RETAIL STORES, AND LOCATIONS WHERE CONSUMER CREDIT SALES/LEASES ARE MADE. ATTACH
ADDITIONAL SHEETS IF NECESSARY.
LOCATION(S)
________________________________________________________________________________________________
Street Address
________________________________________________________________________________________________
City State Zip Code
________________________________________________________________________________________________
Street Address
________________________________________________________________________________________________
City State Zip Code
________________________________________________________________________________________________
Street Address
________________________________________________________________________________________________
City State Zip Code
________________________________________________________________________________________________
Street Address
________________________________________________________________________________________________
City State Zip Code
________________________________________________________________________________________________
Street Address
________________________________________________________________________________________________
City State Zip Code
________________________________________________________________________________________________
Street Address
________________________________________________________________________________________________
City State Zip Code
________________________________________________________________________________________________
Street Address
________________________________________________________________________________________________
City State Zip Code
2017 CONTACT INFORMATION LIST
Colorado Uniform Consumer Credit Code
Please provide the following information and return with your notification form.
Company Name: _____________________________________________________________________
Contact Person for Notification Questions and General Mailings:
Name: _____________________________________________________________________________
Title: ______________________________________________________________________________
Address: ___________________________________________________________________________
___________________________________________________________________________
Email Address: ____________________________ Phone Number: _________________________
Contact Person for Compliance Examinations: Same as Above:
___
Name: _____________________________________________________________________________
Title: ______________________________________________________________________________
Address: ___________________________________________________________________________
___________________________________________________________________________
Email Address: ____________________________ Phone Number: _________________________
Contact Person for Consumer Complaints: Same as Above:
___
Name: _____________________________________________________________________________
Title: ______________________________________________________________________________
Address: ___________________________________________________________________________
___________________________________________________________________________
Email Address: ____________________________ Phone Number: _________________________
2017 OWNERSHIP–COLLECTION ACTIVITY QUESTIONNAIRE
Colorado Uniform Consumer Credit Code
Please provide the following information and return with your notification form.
Company Name:
____________________________________________________________________________
Provide the names of the owners, stockholders of the corporation, or the members of the
limited liability company and the percentage of each owner’s, stockholder’s, or member’s
ownership interest. For corporations: If publicly traded, list all entities holding 10% or
more of the stock; If privately held, the number of shares must equal 100% of stock.
(Attach additional pages if necessary)
Name % of Stock or Member Ownership
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Collection Activity
1. Provide the name and address of each collection agency, engaged by the notifier, to
collect defaulted Colorado consumer credit transactions.
(Attach additional pages if
necessary)
Name of Company Address
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
2. Provide the name and address of each debt buyer to whom the notifier sold defaulted
Colorado consumer credit transactions.
(Attach additional pages if necessary)
Name of Company Address
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
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TELEPHONE: 720-508-6012 YOU MUST COMPLETE ALL SECTIONS AND (Colorado Dept. of Law)

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Completed 20 July 2020

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