Form 440-5218 "Request for Waiver - Oregon Collection Agency Registration" - Oregon

What Is Form 440-5218?

This is a legal form that was released by the Oregon Department of Consumer and Business Services - a government authority operating within Oregon. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2017;
  • The latest edition provided by the Oregon Department of Consumer and Business Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 440-5218 by clicking the link below or browse more documents and templates provided by the Oregon Department of Consumer and Business Services.

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Download Form 440-5218 "Request for Waiver - Oregon Collection Agency Registration" - Oregon

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Oregon Department of Consumer and Business Services
Division of Financial Regulation
350 Winter St. NE, Room 410, Salem, Oregon 97301-388
Mailing address: P.O. Box 14480, Salem, OR 97309-0405
503-378-4140 • Fax: 503-947-7862
http://dfr.oregon.gov
REQUEST FOR WAIVER - OREGON COLLECTION AGENCY REGISTRATION
For collection agencies whose head office is not located in Oregon, this form must be completed to qualify for a waiver of
the Oregon location and trust account in an Oregon financial institution. You must provide the trust account information
below and select one of the three options below. Submit this form with your Oregon Collection Agency registration
application by uploading the document to the NMLS.
We request the following waiver:
Oregon office location
Trust account in an Oregon financial institution
This waives only the requirement to have a trust account in an Oregon financial institution. Complete the following
information about the trust account located in a state other than Oregon:
Trust account name:
Account number:
Name of financial institution:
Address of financial institution:
To qualify for the waiver above, check one of the following:
Applicant has been regulated as a collection agency by the State of Oregon for the two years immediately preceding
this request.
Registration number:
Applicant has been regulated as a collection agency by the State of
,
whose collection agency laws are similar to those of Oregon, for at least five years. We enclose a copy of the current
license/registration certificate, proof of license or registration for five years from another state, and a copy of that
state’s licensing/registration regulations.
Original license/registration date:
License/registration number:
If neither of the proceeding apply: We enclose a $15,000 surety bond or a rider to our existing $10,000 bond,
increasing it to $15,000.
By signing this request for waiver, we agree to provide prompt remittance of debtor funds to our clients. We also agree to
make our books and records available for examination and to pay the cost of out-of-state audits by the Division of
Financial Regulation, including travel, lodging, and per diem expenses.
We attest that the above statements are complete and true.
Name of business as shown on current Oregon collection agency registration or application:
Signature:
Date:
440-5218 (6/17/COM)
Oregon Department of Consumer and Business Services
Division of Financial Regulation
350 Winter St. NE, Room 410, Salem, Oregon 97301-388
Mailing address: P.O. Box 14480, Salem, OR 97309-0405
503-378-4140 • Fax: 503-947-7862
http://dfr.oregon.gov
REQUEST FOR WAIVER - OREGON COLLECTION AGENCY REGISTRATION
For collection agencies whose head office is not located in Oregon, this form must be completed to qualify for a waiver of
the Oregon location and trust account in an Oregon financial institution. You must provide the trust account information
below and select one of the three options below. Submit this form with your Oregon Collection Agency registration
application by uploading the document to the NMLS.
We request the following waiver:
Oregon office location
Trust account in an Oregon financial institution
This waives only the requirement to have a trust account in an Oregon financial institution. Complete the following
information about the trust account located in a state other than Oregon:
Trust account name:
Account number:
Name of financial institution:
Address of financial institution:
To qualify for the waiver above, check one of the following:
Applicant has been regulated as a collection agency by the State of Oregon for the two years immediately preceding
this request.
Registration number:
Applicant has been regulated as a collection agency by the State of
,
whose collection agency laws are similar to those of Oregon, for at least five years. We enclose a copy of the current
license/registration certificate, proof of license or registration for five years from another state, and a copy of that
state’s licensing/registration regulations.
Original license/registration date:
License/registration number:
If neither of the proceeding apply: We enclose a $15,000 surety bond or a rider to our existing $10,000 bond,
increasing it to $15,000.
By signing this request for waiver, we agree to provide prompt remittance of debtor funds to our clients. We also agree to
make our books and records available for examination and to pay the cost of out-of-state audits by the Division of
Financial Regulation, including travel, lodging, and per diem expenses.
We attest that the above statements are complete and true.
Name of business as shown on current Oregon collection agency registration or application:
Signature:
Date:
440-5218 (6/17/COM)