FIS 0510 (08/16) Department of Insurance and Financial Services Debt Management Applicant's Consent to Service of Process KNOW ALL MEN BY THESE PRESENTS: That the undersigned, ____________________________________,corporation, partnership, limited liability company, sole proprietor or other organized under the laws of the State of ___________________ for the purpose of complying with the Debt Management Act, 1975 PA 148, as amended, does hereby irrevocably appoint the Director of the Department of Insurance and Financial Services, and the successors in such office, as its attorney in the State of Michigan upon whom may be served any notice, process or pleading in any action or proceeding against it arising out of or in connection with the debt management business or out of violation of the Debt Management Act; and the undersigned does hereby consent that any such action or proceeding against it may be commenced in any court or competent jurisdiction and proper venue with the State by service of process upon said officer and shall be valid and binding as it service has been made upon the undersigned. By By Title Title Date Date State of _____________________________________ County of ___________________ Subscribed and sworn to me before this ___________ day of ___________________________________. County of________________________, State of __________________. My Commission expires_________________________ ____________________________________________ (Notary Public) 1975 PA 148 as amended requires submission of this form by applicants for a license to do business as a debt management company. Failure to complete and submit this form properly could result in denial, suspension or revocation of your license. American LegalNet, Inc. www.FormsWorkFlow.com