Form 0501RCCD-012A "Civil Applicant Account Update Form" - Nevada

What Is Form 0501RCCD-012A?

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

Form Details:

  • Released on June 1, 2019;
  • The latest edition provided by the Nevada Department of Public Safety;
  • 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 fillable version of Form 0501RCCD-012A by clicking the link below or browse more documents and templates provided by the Nevada Department of Public Safety.

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Download Form 0501RCCD-012A "Civil Applicant Account Update Form" - Nevada

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Records, Communications and Compliance Division
333 West Nye Lane, Suite 100
Carson City, Nevada 89706
Telephone (775) 684-6262 – Fax (775) 687-3232
www.rccd.nv.gov
CIVIL APPLICANT ACCOUNT UPDATE FORM
For use by DPS RCCD Staff Only
Processed By:
(one account per form)
FISCAL
FSU
Date:
ALL information is required unless noted “if
applicable”. Incomplete forms may result in
a processing delay.
Company
Name:
RCCD Account
Number:
Current
New
Federal Tax ID #
If “New”, please provide the previous Federal Tax ID#
Regulatory Authority (If Applicable)
Add
Delete
Physical Location
Billing Address
Response Address
Address Change – applies to (CHECK ALL THAT APPLY):
Physical Address
City – State - Zip
Mailing Address
Billing Contact
City – State - Zip
Response Contact
Add
Delete
Contact Information - applies to (CHECK ALL THAT APPLY):
Name and Title (printed)
Telephone Number
E-mail Address
Fax Number
Billing Contact
Response Contact
Add
Delete
):
Contact Information - applies to (CHECK ALL THAT APPLY
Name and Title (printed)
Telephone Number
E-mail Address
Terms: Statements will be mailed each month. In order to maintain a current account, the balance in full must be paid within 10
Fax Number
days of receipt. If a credit limit is granted for this application, the account may be suspended if the credit limit is exceeded or if the
account is not current. If an account is suspended, services will not be provided until the account terms are satisfied. Any change to
organization information including address must be reported within 10 business days.
(Initial Here)
I, the undersigned, have the authority and am the responsible party to apply for an account on behalf of the Company/
**Any payment on account returned for Non-Sufficient Funds will be assessed a $25.00 fee.**
Organization listed above. I agree to the terms listed above and I understand that any credit limit associated with this account is
at the discretion of the Department of Public Safety, Records, Communications and Compliance Division.
Authorized Company Representative Signature
Date
Authorized Company Representative Name-PRINTED
Title
0501RCCD-012a(06/2019rev)
Civil Applicant Account Update Form
Records, Communications and Compliance Division
333 West Nye Lane, Suite 100
Carson City, Nevada 89706
Telephone (775) 684-6262 – Fax (775) 687-3232
www.rccd.nv.gov
CIVIL APPLICANT ACCOUNT UPDATE FORM
For use by DPS RCCD Staff Only
Processed By:
(one account per form)
FISCAL
FSU
Date:
ALL information is required unless noted “if
applicable”. Incomplete forms may result in
a processing delay.
Company
Name:
RCCD Account
Number:
Current
New
Federal Tax ID #
If “New”, please provide the previous Federal Tax ID#
Regulatory Authority (If Applicable)
Add
Delete
Physical Location
Billing Address
Response Address
Address Change – applies to (CHECK ALL THAT APPLY):
Physical Address
City – State - Zip
Mailing Address
Billing Contact
City – State - Zip
Response Contact
Add
Delete
Contact Information - applies to (CHECK ALL THAT APPLY):
Name and Title (printed)
Telephone Number
E-mail Address
Fax Number
Billing Contact
Response Contact
Add
Delete
):
Contact Information - applies to (CHECK ALL THAT APPLY
Name and Title (printed)
Telephone Number
E-mail Address
Terms: Statements will be mailed each month. In order to maintain a current account, the balance in full must be paid within 10
Fax Number
days of receipt. If a credit limit is granted for this application, the account may be suspended if the credit limit is exceeded or if the
account is not current. If an account is suspended, services will not be provided until the account terms are satisfied. Any change to
organization information including address must be reported within 10 business days.
(Initial Here)
I, the undersigned, have the authority and am the responsible party to apply for an account on behalf of the Company/
**Any payment on account returned for Non-Sufficient Funds will be assessed a $25.00 fee.**
Organization listed above. I agree to the terms listed above and I understand that any credit limit associated with this account is
at the discretion of the Department of Public Safety, Records, Communications and Compliance Division.
Authorized Company Representative Signature
Date
Authorized Company Representative Name-PRINTED
Title
0501RCCD-012a(06/2019rev)
Civil Applicant Account Update Form