California Code of Regulations › Title 10 - Investment › Chapter 3 - Commissioner of Financial Protection and Innovation › Subchapter 13 - Deferred Deposit Transaction Law › Article 1 - Applications › Section 2020 - Application for Deferred Deposit Transaction Licenses

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The application for a deferred deposit
				  transaction license pursuant to Financial Code Section
				  23005(a)
				  shall be filed upon the form set forth in subdivision (c) of this
				  section.
(b) Within 45 calendar
				  days from the receipt of the application under this rule, the Commissioner
				  shall inform the applicant, in writing, that the application is complete and
				  accepted for filing, or that the application is deficient and specify what
				  information is required to complete the application. Within 60 calendar days
				  from the filing of a completed application, the Commissioner shall reach a
				  decision on the license.
(c) An
				  application for a deferred deposit transaction license shall be submitted to
				  the Commissioner on the following form:
(Department of Corporations Use Only)
DEPARTMENT OF CORPORATIONS
Fee Paid $___________________________
File
							 No.___________________________
Receipt No. ___________________________
STATE OF CALIFORNIA DEPARTMENT OF CORPORATIONS
APPLICATION FOR A LICENSE UNDER THE CALIFORNIA DEFERRED
					 DEPOSIT TRANSACTION LAW
__________________________________________________________________________________________
The application must be accompanied by a fee of $300, which
					 includes an application fee of $200 and an investigation fee of $100, both of
					 which are non-refundable. (Financial Code Section
					 23006.) The
					 application (together with the fee payable to the Department of Corporations)
					 must be filed in the Sacramento office of the Department of Corporations,
					 located at 1515 K Street, Suite 200, Sacramento, California 95814.
__________________________________________________________________________________________
The Department of Corporations has established time periods
					 for the processing of permit applicants. These time periods are set forth in
					 the regulations of the Department of Corporations and Financial Code Section
					 23011(c).
					 Failure to comply with these time periods may be appealed to the Secretary of
					 Business, Transportation and Housing Agency, 980 9th Street, Suite 2450,
					 Sacramento, CA 95814-2719, pursuant to the regulations of the Secretary set
					 forth in Chapter 6 (commencing with Section
					 7600) of Title 21 of the
					 California Code of Regulations. Under certain circumstances, the Secretary may
					 require the Department of Corporations to reimburse the applicant for the
					 filing fees paid in connection with the application.
1. Name of applicant:
				  ___________________________________________________________________
Fictitious Business Name:
					 ______________________________________________________
2. Applicant is organized and will do
				  business as (check as applicable):
[ ] an individual
[ ] a partnership
[ ] a corporation
[ ] a limited liability company
[ ] other (please specify)
______________________________________________________________________
3. Applicant's licensed place of business
				  shall be (Financial Code Section
				  23020):
_________________________________________________________________________
(Number and
							 Street)
(City)
(County)
(State)
(Zip)
Provide the following additional information for any mobile
					 unit location:
____________________________________________________________________________________________
(Manufacturer)
(Model)
(Year)
(Color)
(Vehicle
							 Identification No. (VIN))
____________________________________________________________________________________________
(License Plate
							 No.)
(Applicant Identifier (if any))
Proposed area in which the mobile unit will
					 operate:__________
4. The
				  following must be completed if the applicant is an:
Individual:
The FULL first, middle (if no middle name, so indicate) and
					 last name of the individual.
___________________________
(Name)
Those applying for a license as an individual must complete
					 the enclosed form entitled Statement of Citizenship, Alienage, and Immigration
					 Status. (See Exhibit D.)
5.
				  The following must be completed if the applicant is a:
[ ] General Partnership
[ ] Limited
							 Partnership
The partnership applicant was organized on
					 ____________________(Date) in the State of ____________________.
The FULL first, middle (if no middle name, so indicate) and
					 last name, and complete business address MUST be given for each general
					 partner. Indicate if a general partner is the managing general partner.
__________________________________________
(Name)
__________________________________________
(Number and
							 Street)
(City)
(State)
(Zip)
__________________________________________
(Name)
__________________________________________
(Number and
							 Street)
(City)
(State)
(Zip)
__________________________________________
(Name)
__________________________________________
(Number and
							 Street)
(City)
(State)
(Zip)
(Please see Item 6 for persons owning or controlling,
					 directly or indirectly, 10% or more of the outstanding interests. (See
					 Financial Code Section
					 23008.)
6. The following must be completed if the
				  applicant is a:
[ ] Corporation
[ ] Limited Liability
							 Company
[ ] Trust
[ ] Other:
							 ____________________.
Applicant was organized on ____________________(Date) in
					 the State of ____________________.
Indicate if any of the following positions do not exist
					 within the entity selected above. For those positions within the entity, the
					 FULL first, middle (if no middle name, so indicate) and last name, MUST be
					 given for each person(s) occupying the positions listed below: (Attach
					 additional sheets, if necessary.)
President/Chief Executive Officer:
___________________________
(Name)
Executive Vice President/Vice
					 President:
___________________________
(Name)
___________________________
(Name)
Secretary:
___________________________
(Name)
Treasurer/Chief Financial Officer:
___________________________
(Name)
Directors:
___________________________
(Name)
___________________________
(Name)
___________________________
(Name)
Manager(s)/Member(s)
(i.e., a manager
					 member of an association, or a manager appointed or elected by the members of a
					 limited liability company):
___________________________
(Name)
___________________________
(Name)
___________________________
(Name)
Trustee(s):
___________________________
(Name)
___________________________
(Name)
___________________________
(Name)
Any other officer with direct responsibility for the
					 conduct of applicant's deferred deposit activity within the state:
___________________________
(Name)
___________________________
(Name)
___________________________
(Name)
List any person, as defined in Financial Code Section
					 23001 (other than those
					 persons listed above) that owns or controls,
					 directly or indirectly, 10% or more of the applicant. (See Financial Code
					 Section
					 23008):
___________________________
(Name)
___________________________
(Name)
___________________________
(Name)
The FULL first, middle (if no middle name, so indicate),
					 last name, complete business address, telephone number, and e-mail address, if
					 any, must be given for each of the person(s) who will be in charge of the place
					 of business.
_________________________________________________________________
(Name)
(Telephone no.)
(E-mail
							 Address)
_________________________________________________________________
(Number and
							 Street)
(City)
(State)
(Zip)
_________________________________________________________________
(Name)
(Telephone no.)
(E-mail
							 Address)
_________________________________________________________________
(Number and
							 Street)
(City)
(State)
(Zip)
7.
				  Has the applicant been subject to any administrative action in California or
				  any other state? If so, please provide details and attach a copy of any action.
				  If NONE, so state. (Attach additional sheets, if necessary.)
___________________________
___________________________
___________________________
___________________________
___________________________
8. Please provide the name, address, and
				  telephone number of the bonding agent to whom the Department can direct
				  questions regarding the surety bond required in Exhibit B below.
__________________________________________________________
(Bonding Agent)
(Telephone no.)
____________________________________________________________
(Number and
							 Street)
(City)
(State)
(Zip)
9.
				  Please provide a short description of your business plan.
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
10. The following items MUST be provided as
				  exhibits to the application:
EXHIBIT A
. Please provide financial
					 statements, including a balance sheet of the applicant as of a date not more
					 than ninety days prior to the date this application is filed, that indicate a
					 minimum net worth of $25,000. (Financial Code Section
					 23007; the
					 balance sheet may be unaudited.)
EXHIBIT B
. Please provide a copy of a
					 surety bond, including any and all riders and endorsements, in the amount of
					 $25,000. The bond has to be in effect prior to the issuance of a license.
					 Instructions and surety bond form acceptable to the Department of Corporations
					 are enclosed. (Financial Code Section
					 23013.)
EXHIBIT C
. Please provide, for each person
					 named in Items 4, 5, and 6 of this application, a Statement of Identity and
					 Questionnaire, form enclosed (Financial Code Section
					 23008),
					 along with fingerprint information pursuant to California Penal Code Section
					 11077.1 and the
					 cost of fingerprint processing. (Financial Code Section
					 23006.)
EXHIBIT D. FOR INDIVIDUAL APPLICANTS ONLY
.
					 Please complete the enclosed form entitled "Statement of Citizenship, Alienage,
					 and Immigration Status For Application of Department of Corporations License or
					 Certificate." (Title 10 C.C.R. Section
					 250.61.)
EXHIBIT E
. Please retain the enclosed form
					 entitled "Licensee Authorization of Disclosure of Financial Records" and
					 complete and return it to the Corporations Commissioner upon receipt of the
					 license. A person named in Items 4, 5, or 6 of this application who is
					 authorized to sign on behalf of the licensee must sign this form. (Financial
					 Code Sections
					 23005(b),
					 23024.)
EXHIBIT F
. If the applicant will be doing
					 business under a fictitious business name, provide a copy of the Certificate of
					 Filing and Proof of Publication, both of which bear the County Clerk's filing
					 stamp. Refer to Section
					 17000
					 of the Business and Professions Code for the requirements of filing this
					 statement. (Financial Code Section
					 23023.)
EXHIBIT G
. Please submit the following if
					 the applicant is incorporated in the State of California (domestic
					 corporation):
1. An ORIGINAL
				  certificate of good standing or qualification duly executed not more than sixty
				  (60) days before filing this application by the Secretary of State of
				  California showing that the applicant is authorized to do business in this
				  State. The certificate must also indicate the original date of incorporation.
				  (Financial Code Sections
				  23005(b),
				  23015.)
2. A copy of the notice filed with the
				  Department of Corporations that the initial issuance of shares of stock was
				  entitled to an exemption pursuant to Section
				  25102 of
				  the Corporations Code or was qualified for issuance in some other manner.
				  (Financial Code Sections
				  23005(b),
				  23015.)
EXHIBIT H
. Please submit the following if
					 the applicant is incorporated outside of the State of California (foreign
					 corporation): (Financial Code Sections
					 23005(b),
					 23015.)
1. A certificate of good standing or
				  qualification duly executed not more than sixty (60) days before filing this
				  application by the Secretary of State of the foreign state, or other proper
				  authority, showing that the applicant is authorized to transact business in
				  that state. The certificate must also indicate the original date of
				  incorporation.
2 A certificate of good standing or qualification duly
					 executed not more than sixty (60) days before the filing of this application by
					 the Secretary of State of California showing that the applicant is authorized
					 to do business in California.
3. A Consent to Service of Process (form
				  enclosed). Service made pursuant to the terms of the consent to service of
				  process shall have the same force and validity as if served personally on the
				  applicant.
4. Name and address of
				  the principal agent in California.
EXHIBIT I
. If the applicant is a Trust,
					 Limited Partnership or Limited Liability Company (domestic business entity)
					 submit an ORIGINAL certificate of good standing, qualification, or other
					 document duly executed not more than sixty (60) days before filing this
					 application by the Secretary of State of California showing that the applicant
					 is authorized to do business in California. The certificate must also indicate
					 the original date of incorporation. (Financial Code Sections
					 23005(b),
					 23015.)
EXHIBIT J
. Please submit the following if
					 the applicant is a Trust, Limited Partnership or Limited Liability Company
					 organized outside of the State of California (foreign business entity):
					 (Financial Code Sections
					 23005(b),
					 23015.)
1. A certificate of good standing or
				  qualification duly executed not more than sixty (60) days before filing this
				  application by the Secretary of State of the foreign state, or other proper
				  authority, showing that the applicant is authorized to transact business in
				  that state. The certificate must also indicate the original date of
				  incorporation.
2. A certificate of
				  good standing or qualification duly executed not more than sixty (60) days
				  before the filing of this application by the Secretary of State of California
				  showing that the applicant is authorized to do business in
				  California.
3. A Consent to Service
				  of Process (form enclosed). Service made pursuant to the terms of the consent
				  to service of process shall have the same force and validity as if served
				  personally on the applicant.
4.
				  Name and address of the principal agent in California.
EXHIBIT K. DECLARATION REGARDING LAW AND
					 RULES
. Please complete and attach the enclosed declaration regarding
					 the applicant's knowledge of the Deferred Deposit Transaction Law and Rules.
					 Only one responsible officer or director is required to complete this
					 form.
EXHIBIT L: DECLARATION PURSUANT TO FINANCIAL CODE
					 SECTION 23037(i)
. Please complete and attach the enclosed declaration regarding
					 offering, arranging, acting as an agent for, or assisting a deferred deposit
					 originator in the making of a deferred deposit transaction. Only one
					 responsible officer or director is required to complete this form.
EXECUTION SECTION
Please indicate the name, address, title, telephone number
					 and e-mail address (if applicable) of the person who should be contacted for
					 information regarding this application. The license will also be mailed to this
					 person unless otherwise instructed.
Attention:_________________________________________________________
(Name)
(Title)
(Telephone
							 Number)
______________________________________________________________
(Number and
							 Street)
(City)
(State)
(Zip Code)
Email
							 Address:__________________________________________________
In the event of the issuance of a license, applicant agrees
					 to comply with the requirements of the California Deferred Deposit Transaction
					 Law and rules adopted, and orders issued, by the Commissioner of Corporations,
					 and further agrees that in the event of any change of its officers, directors,
					 or any persons named in this application, that an amendment to the application
					 reflecting such change shall within sixty (60) days from the date of the
					 change, be filed with the Commissioner of Corporations setting forth the
					 change, the effective date of the change, the names of the persons involved in
					 the change, and a statement of the qualifications of each successor person.
					 (Financial Code Sections
					 23008,
					 23010.)
WHEREFORE, applicant requests that a license be issued by
					 the Commissioner of Corporations authorizing applicant to engage in business
					 under the California Deferred Deposit Transaction Law within the State of
					 California.
The applicant has duly caused this application to be signed
					 on its behalf by the undersigned, thereunto duly authorized.
The undersigned, on behalf of the applicant, acknowledges
					 that this application and all exhibits thereto which are not designated as
					 confidential are subject to public inspection pursuant to Section
					 250.9.1, Chapter 3, Title 10,
					 California Code of Regulations. A request for confidentiality of certain
					 documents may be requested pursuant to Section
					 250.10. If a request for
					 confidential treatment is granted (or denied), the person making such request
					 will be notified in writing.
I declare under penalty of perjury under the laws of the
					 State of California that I have read the foregoing application, including all
					 exhibits attached thereto, or filed therewith, and know the contents thereof,
					 and that the statements therein are true and correct.
___________________________
(Applicant)
Executed at___________________________
___________________________
(Signature of Declarant)
Date
							 ___________________________
___________________________
(Typed Name)
___________________________
(Title)
STATE OF CALIFORNIA DEPARTMENT OF CORPORATIONS
					 EXHIBIT B INSTRUCTIONS FOR FILING OF SURETY BOND
The attached form contains the approved format for the
					 Surety Bond as required by Financial Code Section
					 23013.
					 Every company is required to obtain and maintain a surety
					 bond.
The original surety bond must be filed and must include all
					 of the following:
1. The signature of
				  the attorney-in-fact for the surety company.
2. A notarial jurat for the
				  attorney-in-fact.
3. A power of
				  attorney from the surety company.
4. Legal name of the licensee. Business
				  name(s), if applicable, may also be included.
5. The signature of the licensee.
6. The notarial jurat for the signature of
				  the licensee.
BEFORE THE DEPARTMENT OF CORPORATIONS OF THE STATE OF
					 CALIFORNIA EXHIBIT BSURETY BOND OF DEFERRED DEPOSIT TRANSACTION LAW LICENSEE
					 FINANCIAL CODE SECTION
					 23013
Bond No. ____________________
KNOW ALL MEN BY THESE PRESENTS:
That we
, as Principal, whose address for service is
___________________________
,
(Street Address, City, State and Zip Code)
and _________________________, a corporation, created,
					 organized and existing under and by virtue of the laws of the State of
					 ____________________ and an admitted Surety insurer authorized to transact a
					 general Surety business in the State of California, as Surety whose address for
					 service is ______________________________(Street Address, City, State and Zip
					 Code), are held and firmly bound unto the Commissioner of Corporations of the
					 State of California, for the use thereof and for the use of any person or
					 persons who may have a cause of action against the Principal under the
					 provisions of the California Deferred Deposit Transaction Law and all laws
					 amendatory thereof and supplementary thereto now and hereafter enacted, in the
					 total aggregate penal sum of ____________________ Dollars ($__________) (see
					 Financial Code Section
					 23013), lawful money of the United
					 States of America, to be paid to the Commissioner of Corporations of the State
					 of California, or to any person or persons, for the use and benefit aforesaid,
					 for which payment well and truly to be made, we bind ourselves, our heirs,
					 executors, administrators, successors and assigns, jointly and severally firmly
					 by these presents.
The condition of the above obligation is such that--
WHEREAS, the above-named Principal has made application to
					 the Commissioner of Corporations of the State of California for a license to
					 engage in business under and pursuant to the provisions of the California
					 Deferred Deposit Transaction Law, and is required under the provisions of the
					 California Deferred Deposit Transaction Law to furnish a bond in the sum above
					 named, conditioned as herein set forth:
NOW, THEREFORE, the Principal, and any and all agents and
					 employees representing the Principal, shall faithfully conform to and abide by
					 the provisions of the California Deferred Deposit Transaction Law and all laws
					 amendatory thereof and supplementary thereto now and hereafter enacted, and of
					 all rules and regulations lawfully made by the Commissioner of Corporations of
					 the State of California under the California Deferred Deposit Transaction Law
					 and shall honestly and faithfully apply all funds received and shall faithfully
					 and honestly perform all obligations and undertakings under the California
					 Deferred Deposit Transaction Law, and shall pay to the Commissioner of
					 Corporations of the State of California and to any person or persons, for the
					 use and benefit aforesaid, any and all moneys which become due or owing the
					 State or to any such person or persons from the Principal under and by virtue
					 of the provisions of the California Deferred Deposit Transaction
					 Law.
This bond is subject to the following provisions:
1. That any person who sustains an injury
				  covered by this bond may, in addition to any other remedy that he or she may
				  have, bring an action in his or her own name upon this bond for the recovery of
				  any damages sustained by him or her.
2. That the total aggregate liability of the
				  Surety or sureties herein shall be limited to the payment of
				  ____________________ Dollars ($_______________) (insert amount of the
				  bond).
3. This bond may be canceled
				  by the Surety in accordance with the provisions of Sections
				  996.320
				  and
				  996.330
				  of the Code of Civil Procedure of the State of California.
4. That, in the event either the Principal
				  and/or the Surety under this bond are served with notice of any action
				  commenced against the Principal or the Surety under the bond, the Principal and
				  Surety as each is served with notice of action shall respectively and, within
				  10 days, give written notice of the filing of such action to the Commissioner
				  of Corporations of the State of California, at the Los Angeles office of the
				  Department of Corporations.
5.
				  That, in the event the Surety under this bond makes full or partial payment on
				  this bond the Surety shall immediately give written notice of such full or
				  partial payment to the Commissioner of Corporations of the State of California,
				  at the Los Angeles office of the Department of Corporations.
6. That the effective date of this bond shall
				  be _________________________.
______________________________
Signature of Principal
______________________________
Typed or Printed Name of Principal
______________________________
Executed at (City and State)
I certify (or declare) under penalty of perjury that I have
					 executed the foregoing bond under an unrevoked power of Attorney.
Executed in _________________________(City and State) on
					 ____________________(Date) under the laws of the State of California.
______________________________
Signature of Attorney-in-Fact for Surety
______________________________
Printed or typed name of Attorney-in-Fact for Surety
ALL OF THE ABOVE SIGNATURES MUST BE NOTARIZEDSTATE OF
					 CALIFORNIA DEPARTMENT OF CORPORATIONS EXHIBIT C
_________________________
_________________________
File No., if any
_________________________
Licensee (Company Name)
(Insert Department of Corporations file number, if
					 any, and the name of the licensee (company) to which this Statement of Identity
					 and Questionnaire relates.)
This document (together with any fingerprint information,
					 if applicable) shall be treated by the Department of Corporations as being
					 received in confidence pursuant to paragraph (4) of subdivision (d) of Section
					 6254 of
					 the Government Code.
STATEMENT OF IDENTITY AND QUESTIONNAIRE
Exact Full
							 Name__________________________________________________________
(Please Print)
First Name
Middle
							 Name
Last Name
(Do not use initials or
							 nicknames)
Position to be filled in connection with the preparation of
					 this questionnaire (
e.g. Officer, Director, Manager,
					 etc.
)
_____________________________________________________________________________________.
_____________________________________________________________________________________
Sex
Hair
Eyes
Height
Weight
Birthdate___________________________
Birthplace___________________________
Social Security or
California
							 Driver's License
Taxpayer's Identification
							 No.___________________________
No., if
							 any___________________________
NOTE:
See Commissioner's Release 2-G (Revised),
					 attached, regarding whether or not furnishing the social security number is
					 mandatory or voluntary and for a description of the use made of that
					 information.
Residence
Business
Hours of
___________________________Phone No.
___________________________ Phone No.
___________________________ Employment
1. Residence
				  addresses for the last 10 years:
From
To
Street
City
State
Present
NOTE: Attach separate schedule if space is not
					 adequate
2. Employment for
				  the last 10 years:
From
To
Employer Name and
							 Address
Occupation and Duties
Present
NOTE: Attach separate schedule if space is not
					 adequate.
3. Have you ever
				  been named in any order, judgment or decree of any court or any governmental
				  agency or administrator, temporarily or permanently restraining or enjoining
				  you from engaging in or continuing any conduct, practice or employment?
[ ] Yes [ ] No
If the answer is "Yes" give details:
___________________________
___________________________
4. Have you ever been refused a license to
				  engage in any business in this state or any other state, or has any such
				  license ever been suspended or revoked?
[ ] Yes [ ] No
If the answer is "Yes" give details:
___________________________
___________________________
5. Have you ever been convicted of or pleaded
				  nolo contendere to a misdemeanor or felony other than traffic violations?
NOTE: "Convicted" includes a verdict of guilty by
					 judge or jury, a plea of guilty or of nolo contendere or a forfeiture of bail.
					 All convictions must be disclosed even if the plea or verdict was thereafter
					 set aside and the charges against you dismissed or expunged or if you have been
					 pardoned. Convictions occurring while you were a minor must be disclosed unless
					 the record of conviction has been sealed under Section
					 1203.45 of the
					 California Penal Code or Section
					 781 of the California Welfare and
					 Institution Code.
[ ] Yes [ ] No
If the answer is "Yes" give details:
___________________________
___________________________
6. Have you ever been a defendant in a civil
				  court action other than divorce, condemnation or personal injury?
[ ] Yes [ ] No
If the answer is "Yes" please complete the
					 following:
Date of suit ____________________ Location of court
					 ____________________
Nature of suit
					 _____________________________________________
7. Have you ever been a subject of a
				  bankruptcy or a petition in bankruptcy?
[ ] Yes [ ] No
If the answer is "Yes" give date, title of case, location
					 of bankruptcy filing:
___________________________
___________________________
___________________________
8. Have you ever been refused a bond, or have
				  you ever had a bond revoked or canceled?
[ ] Yes [ ] No
If the answer is "Yes" give details:
___________________________
___________________________
9. Have you ever changed your name or ever
				  been known by any name other than that herein listed?
(Including a woman's maiden name)
[ ] Yes
					 [ ] No
If so, explain. Change in name through marriage or court
					 order should also be listed. EXACT DATE OF EACH NAME CHANGE MUST BE
					 LISTED.
___________________________
___________________________
10. Have you ever done business under a
				  fictitious firm name either as an individual or in the partnership or corporate
				  form?
[ ] Yes [ ] No
If the answer is "Yes" set forth particulars:
___________________________
___________________________
NOTE: The following questions must be answered by all
					 persons submitting this questionnaire in connection with an ESCROW AGENT'S
					 LICENSE.
11. In what
				  capacity will you be employed?_________________________
(E.g., Clerk,
				  Escrow Officer, Manager, Officer, Director, etc.)
12. Do you expect to be a party to, or broker
				  or salesman in connection with escrows conducted by the escrow company which is
				  employing you?
[ ] Yes [ ] No
If the answer is "Yes" please explain:
___________________________
___________________________
___________________________
NOTE: Attach separate schedule if space is not
					 adequate.
This statement will be considered confidential information
					 and will be filed and maintained as part of the confidential records not
					 subject to public inspection.
VERIFICATION
I, the undersigned, state that I am the person named in the
					 foregoing Statement of Identity and Questionnaire; that I have read and signed
					 said Statement of Identity and Questionnaire and know the contents thereof,
					 including all exhibits attached thereto; and that the statements made therein,
					 including any exhibits attached thereto; are true.
I certify/declare under penalty of perjury that the
					 foregoing is true and correct.
Executed at ____________________ (City)
_________________________________________
(County)
(State)
this __________ day of ____________________,
					 20_____.
______________________________
(Signature of Declarant)
State of ______________________________)
County of ______________________________)
Date_________________________, 20_____
at ______________________________
______________________________
(Signature of Affiant)
Subscribed and sworn to before me
					 ______________________________, 20_____
______________________________
Notary Public in and for said County and State
NOTE:
This verification may be made either before a
					 Notary Public or as a declaration under penalty of perjury. This form MUST be
					 executed before a notary public if it is executed OUTSIDE the State of
					 California.
STATE OF CALIFORNIA DEPARTMENT OF CORPORATIONS
					 EXHIBIT E
LICENSEE AUTHORIZATION FOR DISCLOSURE OF FINANCIAL
					 RECORDS
Pursuant to Financial Code Section
					 23024 and
					 Government Code Section
					 7473, any
					 financial institution, wherever situated, possessing financial records
					 of
___________________________
(Name of Company as appears on Application)Licensed
					 under the
CALIFORNIA DEFERRED DEPOSIT TRANSACTION
					 LAW
is hereby authorized to disclose to the California
					 Department of Corporations records of the above-named business licensed under
					 the above-described Act, whether such records relate to accounts which have
					 been closed, accounts which are currently maintained, or accounts which are
					 hereafter established.
This authorization is effective as of the date of execution
					 and shall remain effective until two (2) years after the expiration or
					 revocation of the above-named business licensed under the above-described Act,
					 including renewals of such license.
This authorization may not be revoked.
The terms used in this authorization shall have the
					 definitions contained in the California Right to Financial Privacy Act
					 (Government Code Section
					 7460 et
					 seq.), and the California Deferred Deposit Transaction Law (Financial Code
					 Section
					 23000 et
					 seq.).
The above-named Licensee has duly caused this authorization
					 to be signed on its behalf by the undersigned, thereunto duly
					 authorized.
Executed on _______________
					 at_________________________(Provide date and city where executed)
______________________________
(Name of Licensee)
By _________________________
(Signature)
_________________________
(Title)
STATE OF CALIFORNIA DEPARTMENT OF
					 CORPORATIONS
INSTRUCTIONS FOR LICENSEE AUTHORIZATION FOR
					 DISCLOSURE OF FINANCIAL RECORDS FORM
On the reverse side is a Licensee Authorization for
					 Disclosure of Financial Records form. The Commissioner of Corporations is
					 authorized to require such authorization from licensees and other persons
					 pursuant to the authority cited in Financial Code Section
					 23024.
The form must be properly executed and submitted prior to
					 the issuance of a license, qualification, registration, or other authority, and
					 as a condition therefor.
All information required on the form, except the signature
					 of the person executing the form, is to be typewritten.
If additional authorization forms are needed, they may be
					 obtained from any office of the Department of Corporations, or an accurate copy
					 of the form may be used by applicant.
TO THE COMMISSIONER OF CORPORATIONS OF THE STATE OF
					 CALIFORNIA
CONSENT TO SERVICE OF PROCESS EXHIBITS H AND
					 J
KNOW ALL MEN BY THESE PRESENTS:
That the undersigned, ______________________________ (a
					 corporation, partnership or limited liability company organized under the laws
					 of the State of ______________________________),
OR
___________________________
(an
							 individual),
OR
___________________________
(other
							 entity)]
hereby irrevocably appoints the Commissioner of
					 Corporations of the State of California, or the Commissioner's successor in
					 office, to be the undersigned's attorney to receive service of any lawful
					 process in any noncriminal suit, action or proceeding against the undersigned,
					 or the undersigned's successor, executor, or administrator which arises under
					 the California Deferred Deposit Transaction Law or any rule or order thereunder
					 after this consent has been filed, with the same force and validity as if
					 served personally on the undersigned.
For the purpose of compliance with the California Deferred
					 Deposit Transaction Law of the State of California, notice of the service and a
					 copy of the process should be sent by registered or certified mail to the
					 undersigned at the following address:
___________________________
(Name and Address)
___________________________
Dated: _________________________, _____.
[Insert name of corporation, partner-
ship, limited liability company or other
entity]
By ______________________________
Title ______________________________
OR
[Insert name of individual]
______________________________
ACKNOWLEDGMENT
State of California _________________________ )
County of______________________________ )
On _______________ before me,
					 ______________________________(insert name and title of the officer) personally
					 appeared ______________________________ who provided to me on the basis of
					 satisfactory evidence to be the person(s) whose name(s) is/are subscribed to
					 the within instrument and acknowledged to me that he/she/they executed the same
					 in his/her/their authorized capacity(ies), and that by his/her/their
					 signature(s) on the instrument are the person(s), or the entity upon behalf of
					 which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the
					 State of California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Signature______________________________ (Seal)
Any certificate of acknowledgement taken in another place
					 shall be sufficient in the State of California if it is taken in accordance
					 with the laws of the place where the acknowledgement is made.
STATE OF CALIFORNIA DEPARTMENT OF CORPORATIONS
					 EXHIBIT KDECLARATION REGARDING LAW & RULES CALIFORNIA DEFERRED DEPOSIT
					 TRANSACTION LICENSE
In the matter of the Application for a License under the
					 California Deferred Deposit Transaction Law, I, the undersigned, authorized to
					 act on behalf of the applicant, declare that the following statements are true
					 and correct:
I (we) have obtained and read copies of the California
					 Deferred Deposit Transaction Law (Division 10 of the California Financial Code)
					 and the Rules (Chapter 3, Title 10, California Code of Regulations) and am
					 familiar with their content; and,
I (we) agree to comply with all of the provisions of the
					 California Deferred Deposit Transaction Law, including any rules or orders of
					 the Commissioner of Corporations.
Additionally, by signing this declaration as provided for
					 on the Execution Page, the applicant hereby agrees (or attests) or declares
					 their understanding of the following items listed below:
1. That the applicant will submit to periodic
				  examinations by the Commissioner of Corporations as required by the California
				  Deferred Deposit Transaction Law.
2. That the applicant will keep and maintain
				  all records for two (2) years following the last entry on a deferred deposit
				  transaction and will enable an examiner to review the record keeping and
				  reconcile each consumer deferred deposit transaction with documentation
				  maintained in the consumer's file records.
3. That the applicant understands the
				  examination process involving the reconciliation of records will be facilitated
				  if the applicant maintains, at a minimum, a ledger or listing of the following
				  current and updated information for each deferred deposit transaction (as
				  specified in Financial Code Section
				  23035):
				  customer's name and address, account number, check number, amount provided,
				  fee, amount of check, corresponding annual percentage rate (e.g. 14-day or
				  30-day), and the deferred due date.
4. That the applicant will maintain a file of
				  all advertising for a period of ninety (90) days from the date of its use,
				  which will be available to the Commissioner of Corporations upon
				  request.
5. That the applicant will
				  file with the Commissioner of Corporations an amendment to this application
				  prior to any material change in the information contained in the application
				  for licensure, including, without limitation, the plan of operation.
6. That the applicant will file with the
				  Commissioner of Corporations any report required by the Commissioner.
7. That the applicant hereby attests that the
				  applicant (including officers, directors and principals) has not engaged in
				  conduct that would be cause for denial of a license. Only one declaration
				  required for each applicant.
I declare under penalty of perjury under the laws of the
					 State of California that the foregoing is true and correct.
Executed on ____________________(date)
					 at_________________________(place).
______________________________
(Signature)
______________________________
(Print name and title)
STATE OF CALIFORNIA DEPARTMENT OF CORPORATIONS
					 EXHIBIT LDECLARATION PURSUANT TO FINANCIAL CODE SECTION
					 23037(i) OF THE
					 CALIFORNIA DEFERRED DEPOSIT TRANSACTION LAW
In the matter of the Application for a License under the
					 California Deferred Deposit Transaction Law, I, the undersigned, authorized to
					 act on behalf of the applicant, declare that the following statements are true
					 and correct:
1. The applicant will
				  comply with all federal and state laws and regulations (including Division 10,
				  commencing with Section
				  23000, of
				  the Financial Code), if it offers, arranges, acts as an agent for, or assists a
				  deferred deposit originator in the making of a deferred deposit transaction.
				  (Financial Code Section
				  23037(i).)
2. The applicant will comply with all of the
				  requirements of the exception specified in paragraphs (1) and (2) of
				  subdivision (i) of Financial Code Section
				  23037, if
				  it offers, arranges, acts as an agent for, or assists a state or federally
				  chartered bank, thrift, savings association, or industrial loan company, in the
				  making of a deferred deposit transaction. (Financial Code Section
				  23037(i)(1)(2).)
Will applicant engage in activities with a financial
					 institution as described in number 2 above?
Yes [ ] No [ ]
I declare under penalty of perjury under the laws of the
					 State of California that the foregoing is true and correct to the best of my
					 knowledge.
Executed on ____________________(Date) at
					 _________________________(City and State).
___________________________.
________________________________
(Signature)
(Print name and
							 title)