Free OFFICE OF THE SECRETARY OF STATE - Texas

Form 2801--General Information (Credit Services Organization Registration Statement)
The attached form is designed to meet minimal statutory filing requirements pursuant to the relevant code provisions. This form and the information provided are not substitutes for the advice and services of an attorney.

Commentary Credit Services Organizations ("CSOs") are governed by chapter 393 of the Texas Finance Code and the secretary of state's administrative rules found in title 1, chapter 74 of the Texas Administrative Code. Section 393.101 sets forth the requirements for a CSO's registration statement. Registration statements are effective the date the completed registration statement and filing fee are received by the secretary of state. The registration expires one year from the date of issuance and may be renewed. This form is for both new registrations and renewals. Any change to the information given on the registration statement must be filed with the secretary of state within 90 days of the change. Instructions for Form · Preliminary Information: Select the appropriate box indicating whether this is a new registration or renewal. If it is a renewal, you should provide the registration number assigned by the secretary of state to facilitate processing of the document. CSO Information: The registration statement must set forth the CSO's name and address. To facilitate filing of the registration statement, you should also include the CSO's telephone number. Owner Information: If the CSO is a corporation or limited liability company, the registration statement must provide the name and address of any person who directly or indirectly owns or controls 10% or more of ownership interest of the entity. If the CSO has more than three owners, use an additional sheet. A document on file with the secretary of state is a public record subject to public access and disclosure. When providing address information for owners, use a business or post office box address rather than a residence address if privacy concerns are an issue. · Statement Regarding Security: Select "A" or "B," whichever is appropriate to indicate whether proof of security is attached or not required. If proof of security is not required, explain why. Litigation Disclosure: The registration statement must disclose all litigation and/or complaints filed with a Texas governmental authority relating to the operation of the credit services organization. If no such litigation or complaint is pending or has been completed, the application must contain a sworn statement to that effect. Attachments: The following items must be included with the application: 1. Proof of security or a statement explaining why proof of security is not required; and 2. Filing fee of $100. · Execution: If the application contains a statement that no litigation and/or complaint is pending or was filed against the CSO, a person authorized to sign on behalf of the CSO must sign and date the registration statement before a notary public or other official who has authority to
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Form 2801

administer an oath. Otherwise, although the document must still be executed by an authorized person, execution before an individual authorized to administer an oath is not required. · Payment and Delivery Instructions: The filing fee for a CSO registration statement or renewal is $100. Fees may be paid by personal checks, money orders, LegalEase, debit cards or MasterCard, Visa, and Discover credit cards. Checks or money orders must be payable through a U.S. bank or financial institution and made payable to the secretary of state. Fees paid by credit card are subject to a statutorily authorized convenience fee of 2.7 percent of the total fees. The completed form, along with the filing fee and proof of security, may be mailed to P.O. Box 13550, Austin, Texas 78711-3550 or delivered to the James Earl Rudder Office Building, 1019 Brazos, Austin, Texas 78701. The secretary of state will issue a certificate of registration upon filing of a completed application.
Revised 04/09

Form 2801

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Form #2801

Rev. 04/2009

This space reserved for office use

Submit to: SECRETARY OF STATE Statutory Documents Section P O Box 13550 Austin, TX 78711-3550 512-475-0775 512-475-2815 - Fax Filing Fee: $100

REGISTRATION STATEMENT FOR A CREDIT SERVICES ORGANIZATION Registration Number:

Application for New Registration Application for Renewal of Registration

Credit Services Organization Information
Name: Address:
Street City State Zip

Phone:

Additional Locations
Address:
Street City State Zip

Address:
Street City State Zip

Address:
Street City State Zip

Owner Information
If corporation or LLC, list each person who directly or indirectly owns or controls 10% or more of the governing interest.

Name: Mailing Address:
Street City State Zip

Name: Mailing Address:
Street City State Zip

Name: Mailing Address:
Street City State Zip

LIST ANY OTHER LOCATIONS AND/OR OWNERS ON A SEPARATE SHEET

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Statement Regarding Security
Complete one of the following:

A. A copy of the surety bond or statement from an authorized depository certifying the establishment and amount of a surety account for each location is attached. OR B. The security requirement of section 393.302, Finance Code is not applicable because:

Litigation Disclosure
Complete one of the following:

A. There has been no litigation or unresolved complaint filed with a Texas governmental authority relating to the operation of the credit services organization named above.
(If option A is selected, execute this document before a notary public or other officer authorized to administer an oath.)

OR B. Litigation and/or complaint(s) filed with a Texas governmental authority relating to the operation of the above-named credit services organization are currently pending or have been completed and are described below:

Attachments
The following items are included with this application: 1. Proof of security, if required; and 2. $100 filing fee.

Execution
Date:
Signature of Authorized Person for Credit Services Organization Printed or typed name of Authorized Person for Credit Services Organization

State of County of

)

) day of
Notary Public Signature

Sworn to and subscribed before me this (seal)

, 20

.

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