Free 635_0203.p65 - Iowa

MICHAEL A. MAURO Secretary of State State of Iowa

CREDIT SERVICES ORGANIZATION REGISTRATION

As required by Iowa Code section 538A.5 the following credit services organization files its registration with the secretary of state. PLEASE READ INSTRUCTIONS ON BACK BEFORE COMPLETING.

1. Name of organization: __________________________________________________________________ 2. Address of organization: ________________________________________________________________
Street Address

___________________________________________________________________________________
City State ZIP

2a. Address in Iowa if different than #2: ________________________________________________________
Street Address

___________________________________________________________________________________
City State ZIP

3. Name and address of any person(s) directly or indirectly controlling 10% or more of the organization:
___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________
(Please attach additional pages if needed)

4. One of the following must be attached (please indicate):
A full and complete disclosure of any litigation or unresolved complaint filed with a governmental authority of this state relating to the operation of the credit services organization. A notarized statement that there has been no litigation or unresolved complaint filed with a governmental authority of this state relating to the operation of the credit services organization.

( ) 5. Phone number of organization: ______________________________________________ 6.
Attached is a copy of the disclosure statement required by Iowa Code section 538A.6(1).
I certify under penalty of perjury and pursuant to the laws of the State of Iowa that the preceding is true and correct. Name _________________________________________________ Title _____________________________________ for (organization name) _____________________________________________________________________________ Signature __________________________________________________________ Date ________________________
635_0203 rev 04/07

The information you provide will be open for public inspection under Iowa Code section 22.11.

NOTES
WHO MUST REGISTER
Iowa Code section 538A.2 defines a credit services organization as a person who, with respect to the extension of credit by others and in return for the payment of money or other valuable consideration, provides or represents that the person can or will provide, any of the following services: a. Improving a buyer's credit record, history, or rating. b. Obtaining an extension of credit for a buyer. c. Providing advice or assistance to the buyer with regard to paragraph "a" or "b". The statute also provides exemptions from registration for banks or savings and loan associations with federally insured deposits, credit unions, certain nonprofit organizations, and attorneys, real estate brokers, and security and commodity dealers acting within the scope of their practices. For a detailed list of exemptions, see Iowa Code section 538A.2(2).

SECURITY
Iowa Code section 538A.3 requires a credit services organization to secure a surety bond or surety account if the credit services organization receives money or other consideration from a buyer prior to performing all agreed upon services. The bond form or a description of the surety account including the depository, the trustee and the account number must be filed in the secretary of state's office.

CHANGE IN REGISTRATION
If any information contained in this registration changes, the credit services organization must notify the secretary of state in writing within 90 days.

INSPECTION OF RECORDS
A current copy of this registration must be kept in the files of the credit services organization and made available to buyers on their request.

DISCLOSURE STATEMENT
Iowa Code section 538A.6(1) provides: 1. Before executing a contract or agreement with a buyer, or receiving money or other valuable consideration, a credit services organization shall provide the buyer with a statement in writing, containing all of the following: a. A complete and detailed description of the services to be performed by the credit services organization for the buyer and the total cost of the services. b. A statement explaining the buyer's right's to proceed against the bond or surety account required by section 538A.4. c. The name and address of the surety company which issued the bond, or the name and address of the depository and the trustee, and the account number of the surety account.

The filing fee is $50.00. Make checks payable to SECRETARY OF STATE. The information you provide will be open to public inspection under Iowa Code chapter 22.11.

SECRETARY OF STATE Credit Services Organization Registration State Capitol, Room 105 Des Moines, Iowa 50319 Phone: (515) 281-8993 FAX: (515) 242-5952 Website: www.sos.state.ia.us

635_0203

MICHAEL A. MAURO Secretary of State State of Iowa

CREDIT SERVICES ORGANIZATION BOND FORM

This is the bond form prescribed by the Secretary of State under Iowa Code section 538A.4. An applicant who chooses to comply with Iowa Code section 538A.4, by executing a surety bond, must use this form.

PRINCIPAL: SURETY: ADMINISTRATOR: Secretary of State BOND NO.: TERM: This bond shall become effective on force until terminated in accordance with the provisions of paragraph 4 below. , as principal, and , 20 and remain in

, as surety qualified to do business in Iowa, are bound in penal sum of $10,000 for payment under the following terms and conditions.

TERMS AND CONDITIONS: 1. The above-named principal has applied to the Secretary of State for registration as a credit services organization under Iowa Code chapter 538A. 2. If the principal complies with the provisions of Iowa Code chapter 538A and all rules and regulations promulgated thereunder, and satisfies any loss or damages suffered by the State of Iowa or any person[s] dealing with the principal resulting from the principal's violation of any provision of Iowa Code chapter 538A, or rules and regulations promulgated thereunder, then this obligation shall be void. Otherwise this bond shall remain in full force and effect. This bond is payable to the State of Iowa for use and benefit of either: (a) [any] person[s] who is [are] injured by the fraud, misrepresentation, or financial failure of the principal ; or (b) the State on behalf of any person[s] so injured. 3. This bond shall be one continuing obligation and in no event shall the liability exceed the penal sum of $10,000 for the aggregate of any claims occurring during the term of this bond. 4. The surety shall have the right to terminate its obligation under this bond by filing written notice of its intent to cancel the bond with the Secretary of State and the principal at least 30 days prior to the effective date of such termination. Obligations of the surety arising prior to the effective date shall not be affected by the termination.

EXECUTED on this

day of , Principal

, 20

by

.

NOTE: Persons executing for surety other than corporate officers must attach Power of Attorney.

, Surety by .
635_0204 04/03

MICHAEL A. MAURO Secretary of State State of Iowa

SURETY ACCOUNT NOTICE FOR A CREDIT SERVICES ORGANIZATION

TO: Secretary of State, Credit Services Organization Registration, State Capitol, Room 105, Des Moines Iowa 50319 A surety account has been established in favor of the State of Iowa at: __________________________________________________________________________________________
(Name and Address of Financial Institution)

with _________________________________ as Trustee by ___________________________________________
(Name of Trustee) (Officer or Authorized Agent of Credit Services Organization)

for _________________________________________________________________________________________
(Name of Credit Services Organization)

___________________________________________________________________________________________
(Address of Credit Services Organization)

Account Number:______________________ AMOUNT: $10,000 Date Established:________________________

No money in this account may be conveyed to the Credit Services Organization or its representative without written approval by the Secretary of State.

Signature of Officer of Financial Institution: __________________________________________________________ Name and Title of Officer: _______________________________________________________________________ Date: __________________________________

TERMS AND CONDITIONS: 1. The above-named principal has applied to the Secretary of State for registration as a credit services organization under Iowa Code chapter 538A. 2. If the principal complies with the provisions of Iowa Code chapter 538A and all rules and regulations promulgated thereunder, and satisfies any loss or damages suffered by the State of Iowa or any person[s] dealing with the principal resulting from the principal's violation of any provision of Iowa Code chapter 538A, or rules and regulations promulgated thereunder, then this obligation shall be void. Otherwise this surety account shall remain in full force and effect. This surety account is payable to the State of Iowa for use and benefit of either: (a) [any] person[s] who is [are] injured by the fraud, misrepresentation, or financial failure of the principal ; or (b) the State on behalf of any person[s] so injured. 3. This surety account shall be one continuing obligation and in no event shall the liability exceed the penal sum of $10,000 for the aggregate of any claims occurring during the term of this surety account. 4. A depository holding money in a surety account shall not convey money in the account to the credit services organization that established the account or a representative of the credit services organization unless the credit services organization or representative presents a statement issued by the secretary of state indicating that section 538A.5 subsection 6, has been satisfied in relation to the account. 5. The surety account shall be maintained until two years after the date that the credit services organization ceases to operate.
635_0205 04/07