FILE ONE ORIGINAL (Two if you want a filed datestamped copy returned to you)FEE: $50 1.The name of the Credit ServicesOrganization is:2.The address of the principal office of theorganization: (Address) (City, State, Zip Code) 3.The name and address where Notice ofProcess may be sent: (Address) (City, State, Zip Code) 4.Please check the statement that relates to your organization:No, our organization does not collect any money from prospective borrowers prior to completion of services rendered. Therefore, no bond is required to be filed with the Office of Secretary of State.Yes, our organization does collect money from prospective borrowers prior to completion of services rendered, therefore we are filing a $15,000 Surety Bond with the Office of Secretary of State. 5.List person(s) who own(s) or control(s) more than 10% of the outstanding shares of stock of thisorganization (attach additional pages if necessary).NameStreet Address, City, State, Zip CodeNameStreet Address, City, State, Zip Code 6.List a full and complete disclosure of any litigation or unresolved complaints filed with a governmentalauthority of this state relating to the operation of the credit service organization. If no litigation existscheck the appropriate statement and have it notarized (attach additional pages if necessary).Case Name or Agency:Case Number: Location of Court: Decision/Results/or Complaint: Form CSO-1 Rev. 11/2017 CREDIT SERVICES ORGANIZATION REGISTRATION STATEMENT West Virginia Secretary of State Business & Licensing Division Tel: (304)558-8000 Fax: (304)558-8381 Website: www.wvsos.gov CREDIT SERVICES ORGANIZATION REGISTRATION STATEMENT Page 2 Case Name or Agency:Case Number:Location of Court: Decision/Results/or Complaint: 7.If no litigation exists check the statement below, sign, and have it notarized.I, , have the authority to represent the credit service organization filing this application and I do solemnly attest, under penalty of perjury, that this organization has never been involved in litigation involving its operations or that this organization has had no complaints filed with any government agency.SignatureType or print name Acknowledgement: State of: County of:I, , a Notary Public in and for the county and state aforesaid, do hereby certify that whose name is signed to the foregoing, has this day acknowledged the same before me in my said county. Given under my hand on this date:My commission expires:Signature of Notary 8.Signature* of registrant and contact information:Signature of person filing on behalf of organization Date of signingName of contact person to reach in case of problem with filing Phone number (Optional, however, listing one may help to avoid delays in processing the application) 9.Business e-mail address, if any:*Important Legal Notice Regarding Signature :Corporations/Voluntary Associations/Business Trusts/Unincorporated Nonprofit Associations/Limited Partnerships 226 Per West Virginia Code24731D-1-129 . Penalty for signing false document. Any person who signs a document he or she knows is false in any material respect and knows that the document is to be delivered to the Secretary of State for filing is guilty of a misdemeanor and, upon conviction thereof, shall be fined not more than one thousand dollars or confined in the county or regional jail not more than one year, or both. Limited Liability Companies/Limited Liability Partnerships - PerWest Virginia Code24731B-2-209 . Liability for false statement in filed record. If a record authorized or required to be filed under this chapter containsa false statement, one who suffers loss by reliance on the statement may recover damages for the loss from a person who signed the record or caused another to sign it on the person's behalf and knew the statement to be false at the time the record was signed. X 24746A-6C-2. Credit services organization.(a) A credit services organization is 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: (1) Improving a buyer's credit record, history or rating; (2) Obtaining an extension of credit for a buyer; or (3) Providing advice or assistance to a buyer with regard to subdivision (1) or (2) of this subsection. (b) The following are exempt from this article: (1) A person authorized to make loans or extension of credit under the law of this state or the United States who is subject to regulation and supervision by this state or the United States, or a lender approved by the United States secretary of housing and urban development for participation in a mortgage insurance program under the National Housing Act (12 U. S. C. Section 1701, et seq.); (2) A bank or savings and loan association whose deposit or accounts are eligible for insurance by the federal deposit insurance corporation or the federal savings and loan insurance corporation or a subsidiary of such a bank or savings and loan association; (3) A credit union doing business in this state; (4) A nonprofit organization exempt from taxation under Section 501(c)(3) of the Internal Revenue Code of 1986; (5) A person licensed as a real estate broker or salesman under the Real Estate Brokers License Act acting within the course and scope of that license; (6) A person licensed to practice law in this state acting within the course and scope of the person's practice as an attorney; (7) A broker-dealer registered with the securities and exchange commission or the commodity future trading commission acting within the course and scope of that regulation; (8) A consumer reporting agency; (9) A person whose primary business is making loans secured by liens on real property; (10) A person whose primary business is the retail sale of automobiles and trucks: Provided, That the person is not extending credit for a buyer, excluding assignments; and (11) A person licensed to practice public accounting in this state acting within the course and scope of the person's practice as an accountant. 24746A-6C-4. Bond; surety account.(a) This section applies to a credit services organization required by section three of this article to obtain a surety bond or establish a surety account. (b) If a bond is obtained, a copy of it shall be filed with the secretary of state. If a surety account is established, notification of the depository, the trustee, and the account number shall be filed with the secretary of state. (c) The bond or surety account required must be in favor of the state of the benefit of any person who is damaged by any violation of this article. The bond or surety account must also be in favor of any person damaged by such a violation. (d) Any person claiming against the bond or surety account for a violation of this article may maintain an action at law against the credit services organization and against the surety or trustee. The surety or trustee shall be liable only for damages awarded under section nine of this article and not the punitive damages permitted under that section. The aggregate liability of the surety or trustee to all persons damaged by a credit services organization's violation of this chapter may not exceed the amount of the surety account or bond. (e) The bond or the surety account shall be in the amount of fifteen thousand dollars. (f) A depository holding money in a surety account under this chapter may 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 five of this article has been satisfied in relation to the account. The secretary of state may conduct investigations and require submission of information as necessary to enforce this subsection. 24746A-6C-5. Registration.(a) A credit services organization shall file a registration statement with the secretary of state before conducting business in this state. The registration statement shall contain: (1) The name