Form CA3 "Branch Office Registration Form for Collection Agencies, Debt/Credit Counselors, Debt Settlement Companies, Debt Buyers, and Credit Repair Organizations" - Idaho

What Is Form CA3?

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

Form Details:

  • Released on February 1, 2019;
  • The latest edition provided by the Idaho Department of Finance;
  • 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 CA3 by clicking the link below or browse more documents and templates provided by the Idaho Department of Finance.

ADVERTISEMENT
ADVERTISEMENT

Download Form CA3 "Branch Office Registration Form for Collection Agencies, Debt/Credit Counselors, Debt Settlement Companies, Debt Buyers, and Credit Repair Organizations" - Idaho

Download PDF

Fill PDF online

Rate (4.8 / 5) 12 votes
BRANCH OFFICE REGISTRATION FORM FOR
COLLECTION AGENCIES, DEBT/CREDIT COUNSELORS, DEBT SETTLEMENT COMPANIES, DEBT
BUYERS, AND CREDIT REPAIR ORGANIZATIONS FORM
CA3 INSTRUCTIONS
A. GENERAL INSTRUCTIONS
1. FILING – Form CA3 is the Branch Office Registration Form accompanying the Form CA1- License Application Form for
Collection Agencies, Debt/Credit Counselors, Debt Settlement Companies, Debt Buyers, & Credit Repair Organizations.
2. TERMS USED – See the following Explanation of Terms section regarding italicized words/phrases.
3. EXECUTION – The execution section must be completed by an authorized representative of the applicant/licensee.
4. DATES – The filing date is the date applicant submits this form to the Idaho Department of Finance. The desired effective
date is the date applicant/licensee would like this registration or amendment to become effective.
5. AMENDMENTS – The applicant/licensee must update information about a branch office by submitting amendments using
Form CA3. When making changes to an existing branch registration, check the “amendment” box on line 1, provide all
previous information in items 2a through 6a, filing and effective dates, license number where applicable, and complete
only the information that is being amended in item(s) 2b through 6b or 7 through 11.
6. CONTACT EMPLOYEE – The individual listed on the applicant’s Form CA1 (company’s main office) as the contact
employee will be contacted by the Idaho Department of Finance, if needed, about this branch Form CA3.
7. RECORDS – Please identify where records will be kept if the applicant/licensee intends to maintain records for the branch
office at a location other than the main address of the applicant/licensee or the location specified in item 2(C) on Form
CA1.
8. SURRENDER / CANCEL– When an applicant/licensee decides to cease operations under this branch registration, at one
or more branch locations, use the Form CA3 to notify the Idaho Department of Finance by checking the “surrender” box
and completing only items 2, 7, and 8. Submit a separate Form CA3 for each branch registration that is being
surrendered. Use the Form CA1 to notify the Department if the entire company will cease operations under the
license/registration.
B. FILING INSTRUCTIONS
1. FORMAT
A. Form CA3 may accompany a new company filing with Form CA1, or may follow the Form CA1 at a later date. A fully
completed Form CA3 must be submitted when the applicant is filing for branch registration the first time.
B. The Execution section must include a notarized original manual signature for the initial Form CA3 filing for each
branch office.
C. Type or print all information clearly and legibly.
D. Use only the current version of Form CA3.
2. ATTACHMENTS
A. Responsible Person in Charge (RPIC): This person must demonstrate a minimum of three (3) years’ experience
specifically related to the type of business conducted by the licensee under the Idaho Collection Agency Act. This
person does not have to be an owner, officer, member, partner or director. This person does not have to physically
work from the main licensed office location; however, if the RPIC works from any other location, a toll-free number to
reach this person during normal business hours must be provided to Idaho debtors and the Department. A
verification of experience that includes detailed job descriptions, duties, experience and/or relevant education in each
of the specific business activities to be conducted under this license. If multiple activities are to be conducted— such
as collections and credit repair, three (3) years of experience in EACH activity must be documented and detailed. File
a Form CA2 for the RPIC if different than the RPIC filed in Form CA1.
B. Provide a file-stamped copy of the Certificate of Assumed Business Name issued by the Idaho Secretary of State
(IDSOS) for use of any fictitious, trade or “doing business as” name(s) to be used in Idaho at this branch location if
not previously filed and approved with the Department. Contact the IDSOS at 208.334.2300 for filing information.
C. Individual(s) having contact with Idaho debtors or businesses while conducting business activities covered by the
Idaho Collection Agency Act must be registered on the Notification of Agents/Collectors Form and pay a $20
Registration Fee per person (this is an annual fee after initial payment at the time of registration).
E. There is no application fee for a branch registration.
C. EXPLANATION OF TERMS – The following terms are italicized throughout Form CA3
APPLICANT – The collection agency, debt counselor, credit counselor, debt settlement company, debt buyer or credit repair
organization applying on or amending information on this form for a branch registration. The only instance in which the
applicant is an individual is in the case of a sole proprietorship.
JURISDICTION – A state, the District of Columbia, the Commonwealth of Puerto Rico, or any subdivision or regulatory body
thereof.
PERSON –An individual, partnership, corporation, trust or other organization.
Form CA3 Rev 2/2019
Page 1 of 4
BRANCH OFFICE REGISTRATION FORM FOR
COLLECTION AGENCIES, DEBT/CREDIT COUNSELORS, DEBT SETTLEMENT COMPANIES, DEBT
BUYERS, AND CREDIT REPAIR ORGANIZATIONS FORM
CA3 INSTRUCTIONS
A. GENERAL INSTRUCTIONS
1. FILING – Form CA3 is the Branch Office Registration Form accompanying the Form CA1- License Application Form for
Collection Agencies, Debt/Credit Counselors, Debt Settlement Companies, Debt Buyers, & Credit Repair Organizations.
2. TERMS USED – See the following Explanation of Terms section regarding italicized words/phrases.
3. EXECUTION – The execution section must be completed by an authorized representative of the applicant/licensee.
4. DATES – The filing date is the date applicant submits this form to the Idaho Department of Finance. The desired effective
date is the date applicant/licensee would like this registration or amendment to become effective.
5. AMENDMENTS – The applicant/licensee must update information about a branch office by submitting amendments using
Form CA3. When making changes to an existing branch registration, check the “amendment” box on line 1, provide all
previous information in items 2a through 6a, filing and effective dates, license number where applicable, and complete
only the information that is being amended in item(s) 2b through 6b or 7 through 11.
6. CONTACT EMPLOYEE – The individual listed on the applicant’s Form CA1 (company’s main office) as the contact
employee will be contacted by the Idaho Department of Finance, if needed, about this branch Form CA3.
7. RECORDS – Please identify where records will be kept if the applicant/licensee intends to maintain records for the branch
office at a location other than the main address of the applicant/licensee or the location specified in item 2(C) on Form
CA1.
8. SURRENDER / CANCEL– When an applicant/licensee decides to cease operations under this branch registration, at one
or more branch locations, use the Form CA3 to notify the Idaho Department of Finance by checking the “surrender” box
and completing only items 2, 7, and 8. Submit a separate Form CA3 for each branch registration that is being
surrendered. Use the Form CA1 to notify the Department if the entire company will cease operations under the
license/registration.
B. FILING INSTRUCTIONS
1. FORMAT
A. Form CA3 may accompany a new company filing with Form CA1, or may follow the Form CA1 at a later date. A fully
completed Form CA3 must be submitted when the applicant is filing for branch registration the first time.
B. The Execution section must include a notarized original manual signature for the initial Form CA3 filing for each
branch office.
C. Type or print all information clearly and legibly.
D. Use only the current version of Form CA3.
2. ATTACHMENTS
A. Responsible Person in Charge (RPIC): This person must demonstrate a minimum of three (3) years’ experience
specifically related to the type of business conducted by the licensee under the Idaho Collection Agency Act. This
person does not have to be an owner, officer, member, partner or director. This person does not have to physically
work from the main licensed office location; however, if the RPIC works from any other location, a toll-free number to
reach this person during normal business hours must be provided to Idaho debtors and the Department. A
verification of experience that includes detailed job descriptions, duties, experience and/or relevant education in each
of the specific business activities to be conducted under this license. If multiple activities are to be conducted— such
as collections and credit repair, three (3) years of experience in EACH activity must be documented and detailed. File
a Form CA2 for the RPIC if different than the RPIC filed in Form CA1.
B. Provide a file-stamped copy of the Certificate of Assumed Business Name issued by the Idaho Secretary of State
(IDSOS) for use of any fictitious, trade or “doing business as” name(s) to be used in Idaho at this branch location if
not previously filed and approved with the Department. Contact the IDSOS at 208.334.2300 for filing information.
C. Individual(s) having contact with Idaho debtors or businesses while conducting business activities covered by the
Idaho Collection Agency Act must be registered on the Notification of Agents/Collectors Form and pay a $20
Registration Fee per person (this is an annual fee after initial payment at the time of registration).
E. There is no application fee for a branch registration.
C. EXPLANATION OF TERMS – The following terms are italicized throughout Form CA3
APPLICANT – The collection agency, debt counselor, credit counselor, debt settlement company, debt buyer or credit repair
organization applying on or amending information on this form for a branch registration. The only instance in which the
applicant is an individual is in the case of a sole proprietorship.
JURISDICTION – A state, the District of Columbia, the Commonwealth of Puerto Rico, or any subdivision or regulatory body
thereof.
PERSON –An individual, partnership, corporation, trust or other organization.
Form CA3 Rev 2/2019
Page 1 of 4
BRANCH OFFICE REGISTRATION FORM FOR COLLECTION
FORM CA3
AGENCIES, DEBT/CREDIT COUNSELORS, DEBT SETTLEMENT
COLLECTION AGENCY
COMPANIES, DEBT BUYERS, AND CREDIT REPAIR
DEBT SETTLEMENT
ORGANIZATIONS
Applicants full legal name: ____________________________________
DEBT BUYER
DEBT/CREDIT
COUNSELOR
Date of filing (MM/DD/YYYY):
Desired Effective Date (MM/DD/YYYY):
CREDIT REPAIR
Complete column items with “b” for the item(s) being amended
1.
NEW APPLICATION
AMENDMENT:
.
SURRENDER/CANCEL
OTHER ______________________________
2a.
2b.
___________________________________________
____________________________________________________
NEW Physical address (Number and Street)
Physical address (Number and Street)
___________________________________________
___________________________________________________
Physical City, State/Country, Zip+4/Postal Code
NEW Physical City, State/Country, Zip+4/Postal Code
3a.
3b.
__________________________________________
___________________________________________________
Mailing address or P.O. Box (if different from Physical)
NEW Mailing address or P.O. Box (if different from Physical)
__________________________________________
___________________________________________________ NEW
Mailing address City, State/Country, Zip+4/Postal Code
Mailing address City, State/Country, Zip+4/Postal Code
4a.
4b.
(____) -__________________________ ext _______
(____) -__________________________________ ext _______
NEW Business (Area Code) and Telephone Number
Business (Area Code) and Telephone Number
____________________________________________________
___________________________________________
NEW Branch website
Branch website (list all websites used by the branch to
solicit debtors and business clients)
5a.
5b.
___________________________________________
____________________________________________________
NEW Trade name or “dba” used at this branch
Other Trade names or “dba” used at this branch
6a.
6b.
Each branch must have at least one Responsible Person in Charge (RPIC)
Each branch must have at least one Responsible
with a completed and filed Form CA2 and verification of experience
Person in Charge (RPIC) with a completed and filed
Form CA2 and verification of experience.
____________________________________________________ NEW
__________________________________________
Branch Responsible Person Name
Branch Responsible Person Name
EXECUTION: The undersigned, being first duly sworn, deposes and says that he/she has executed this form on behalf of, and
with the authority of, said applicant and agrees to and represents the following:
That the information and statements contained herein, including exhibits attached hereto, and other information filed
(1)
herewith, all of which are made a part hereof, are current, true and complete;
To the extent any information previously submitted is not amended such information is currently accurate and complete;
(2)
That the Idaho Department of Finance may conduct any investigation in accordance with state law, into the background of
(3)
the applicant for purposes of this registration;
To keep the information contained in this form current and to file accurate supplementary information on a timely basis;
(4)
To keep accurate books and records or otherwise comply with the provisions of law pertaining to the conduct of business for
(5)
which the applicant is applying.
Form CA3 Rev 2/2019
Page 2 of 4
___________________________________________
___________________________________
Signature of applicant’s representative
Date (MM/DD/YYYY)
Signed or attested before me: ____________________
by ________________________________
Print applicant’s representative name
Print Notary Public name
on this __ ____ day of _____________, ________ at
________
_____________
Notary seal here
Date
Month
Year
State
County
__________________________________________ __________________________________
Notary Public signature
Notary Appointment Expires (MM/DD/YYYY)
This execution must always be completed in full with original, manual signature and notarization. Affix
notary stamp or seal where applicable.
Form CA3 Rev 2/2019
Page 3 of 4
7.
Physical address of location where the official books and records generated by this branch office will be kept.
______________________________________________________________________________________________
Check here if same as previously specified principal records location (Item 2C on Form CA1). If multiple custodians maintain records
for this branch, attach a separate sheet and indicate the types of records each custodian keeps.
___________________
(
)_______________
(
)_______________
________________________ email address
Records Custodian
Business Phone
Fax Line
Name
____________________
___________________
_____________________
_________________________
State / Province &
Number & Street
City
Zip+4 / Postal Code
Country
8
Enter appropriate number in the box(es) for each jurisdiction:
Use the CA box for collection agency/debt buyer, the DCC box for debt/credit counselor or Debt Settlement, and the CR box for
credit repair.
Enter “1” if applicant is newly applying in that jurisdiction
Enter “2” if applicant has a pending application in that jurisdiction
Enter “3” if applicant is already licensed/registered in that jurisdiction
Enter “4” if
applicant is surrendering/canceling in that jurisdiction
Enter “5” if applicant was formerly licensed/registered in that jurisdiction
CA
DCC
CR
CA
DCC
CR
CA
DCC CR
CA
DCC CR
Alabama
Idaho
Montana
Rhode Island
Alaska
Illinois
Nebraska
South Carolina
Arizona
Indiana
Nevada
South Dakota
Arkansas
Iowa
New
Tennessee
Hampshire
California –
Texas – OCCC
Kansas
New Jersey
DOC
California –
Texas – SML
Kentucky
New Mexico
DRE
Colorado
Louisiana
New York
Utah
Connecticut
Maine
North
Vermont
Carolina
Delaware
Maryland
North
Virginia
Dakota
District of
Ohio
Washington
Columbia
Massachusetts
Florida
Michigan
Oklahoma
West Virginia
Georgia
Minnesota
Oregon
Wisconsin
Guam
Mississippi
Wyoming
Pennsylvania
Hawaii
Missouri
Puerto Rico
9.
Will this branch office and/or individuals at this branch office operate pursuant to a written agreement
or contract with the main office?
Y
N
10. Will this branch office have sole responsibility for decisions relating to individuals collecting, settling debt,
repairing credit, counseling or soliciting debtors or businesses for collection-related services:
Y
N
(a) with respect to employment?
Y
N
(b) with respect to compensation?
Y
N
Form CA3 Rev 2/2019
Page 4 of 4
Page of 4