Non-Refundable Processing Fee: [ ] Registration $32.00 [ ] Renewal $32.00 When renewing the collection agency, the bond date must match the collection agency222s registration date. 1.Registered business name: 2.Business street address: Street Address City State Zip 3.Date business formed or incorporated: 4.Name of the principal applicant-owner of the agency or authorized officer of the corporation:5.Principal's Address: Street Address City State Zip All applications must include original surety bond written for 1 (one) year. Signature of Applicant Date Where to file: You may file in person or by mail. Means of payment are: cash, check, or money order. Non-refundable processing fee of $32.00. State of Utah Department Of Commerce Division of Corporations & Commercial Code A pp lication for Collection A g enc y Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, you may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity. American LegalNet, Inc. www.FormsWorkFlow.com