Section 177.ILLUSTRATION A – Credit Services Organization Registration Statement

 

STATE OF ILLINOIS

CREDIT SERVICES ORGANIZATION

REGISTRATION STATEMENT

($100 Filing Fee)

 

This registration statement, along with a $100 filing fee and a $100,000 surety bond are to be filed with the Secretary of State, Index Department, 111 East Monroe Street, Springfield, IL 62756.

 

When a change in the information contained in this statement occurs the credit services organization is required to file an amended statement within 90 days.  There is no fee for filing amended statements.

 

A credit services organization is required to continuously maintain a $100,000 surety bond if that credit services organization charges or receives any money or other valuable consideration prior to full and complete performance of the services the credit services organization has agreed to perform.  A bond shall also be maintained for a period of 2 years after the date that the organization ceases operations.

 

A file-stamped copy of this statement will be returned to the credit services organization who must maintain the copy in their files and allow a buyer to inspect the registration statement.

 

1.         Name and address of the credit services organization.

 

 

2.         Name and address of the registered agent or individual authorized to accept service of process on behalf of the credit services organization.

 

 

3.         Name and address of any and all persons who directly or indirectly own or control 10 percent or more of the outstanding shares of stock in the credit services organization. (If additional space is needed, attach a listing)

 

 

4.         If any, the bond number, name and location of the surety company issuing a $100,000 surety bond as required by the Credit Services Organizations Act.

 

	Bond number:

 

5.         (A)      Has there been any litigation or unresolved complaint filed with a governmental authority of this State, any other state or the United States relating to the operation of this Credit Services Organization?               No        Yes

 

If answer is yes, you must attach a full and complete disclosure.

 

(B)      If there has been no litigation or unresolved complaint filed, the following statement must be completed and notarized.

 

	I,			,
		name			official capacity
	of
			name of credit services organization

do hereby affirm that there has been no litigation or unresolved complaint filed with a governmental authority of this State, any other State or the United States relating to the operation of this credit services organization.

 

 

 

 

		signature
Subscribed and affirmed to before me on			, 19		.
		signature of notary public
	(seal)

 

 

 

 

 

6.         I do hereby affirm that the foregoing statements and any attachments are true and correct.

 

 

 

		signature
		official capacity
Subscribed and affirmed to before me on			, 19		.
		signature of notary public
	(seal)

 

Section 177.ILLUSTRATION B – Credit Services Organization Surety Bond

 

STATE OF ILLINOIS

CREDIT SERVICES ORGANIZATION

$100,000 SURETY BOND

 

File with Secretary of State, Index Department, 111 East Monroe Street,

Springfield, IL  62756

 

(Required by Public Act 85-1384,

effective January 1, 1989)

 

 

Bond Number
Premium $			Term

 

KNOW ALL PERSONS BY THESE PRESENTS:

 

That
			Name of Principal
as principal, doing business under the name of										,
				Name of Business
a credit services organization, and whose address for services is
	Street Address									,
	City				State			Zip
and									, a corporation
		Name of Surety

authorized to transact a general surety business in the State of Illinois, as surety, are held firmly bound unto the People of the State of Illinois in the penal sum of $100,000, for the payment of which, we bind ourselves, our heirs, executors, successors and assigns, jointly and severally, firmly by these presents.

 

The principal is engaged in the business of selling the services of a credit services organization within the meaning of the "Credit Services Organizations Act" (Public Act 85-1384, approved September 1, 1988, effective January 1, 1989) and is required to furnish a bond conditioned as herein set forth; and this bond is executed and tendered in accordance therewith.

 

The conditions of this obligation are that if the principal complies with the provisions of the "Credit Services Organizations Act" and does not damage any person by any violation of said Act then this obligation is to be void, otherwise it is to remain in full force and effect.

 

Any person damaged by any violation of the "Credit Services Organizations Act" may bring an action of law against the principal and surety on this bond in his or her own name to recover such damages.

 

The liability of surety for any claim arising under this bond shall not exceed the actual damages arising from principal's violation of the "Credit Services Organizations Act" and surety shall not be liable for the punitive damages permitted under Section 11 of the Act.

 

The aggregate liability of the surety on all claims whatsoever shall not exceed the amount of this bond.

 

This bond is executed by the surety to comply with the provisions of the "Credit Services Organizations Act" and said bond shall be subject to all of the terms and provisions thereof.

 

Name of Officer of Business		Name of Surety
Address		Address

 

This bond is executed under an unrevoked appointment or power of attorney.

 

I certify (or declare) under penalty of perjury under the laws of the State of Illinois that the foregoing is true and correct.

 

Date		Signature of Attorney-In-Fact
		Printed or Typed Name of Attorney-In-Fact

 

*          *          *

A credit services organization is required to continuously maintain a $100,000 surety bond.  A bond shall also be maintained for a period of 2 years after the date that the organization ceases operations.