Fillable Printable Collection Agency - Business Licensing Service

Collection Agency - Business Licensing Service

State of Washington

Business Licensing Service

PO Box 9034

Olympia, WA 98507-9034

1-800-451-7985

Collection Agency, Branch Ofﬁce, or Out-Of-State Ofﬁce

Addendum

Please read the next page for complete application instructions.

Owner/business name

UBI number

A Ofﬁce contact information

Name of contact person who works at the location (Area code) telephone number

Location address as shown on Business License Application street or route, city, state, zip code

B Sole proprietor/ofﬁcer/partners/general manager information

In this state or any other jurisdiction, or (have) any business owners, any persons with controlling interest in this

business, or the business entity:

1. Within the last 10 years, defaulted or been convicted of or entered a plea of no contest to a gross

misdemeanor or felony crime? (Don't include trafﬁc offenses.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes No

2. Currently under indictment, or is there a criminal complaint, charge, or information pending against

you? ............................................................................. Yes No

3. Within the last 10 years, had any action (ﬁne, suspension, revocation, censure, surrender, etc.) taken

against any professional or occupational license, certiﬁcation, or permit held by you? .............. Yes No

4. Within the last 10 years, had any civil court order, verdict, or judgment entered against you?......... Yes No

5. Petitioned for bankruptcy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

If the answer to any of these questions is Yes, please attach a letter of explanation to this form. Include the name of

the person or business involved, charge(s), date of conviction, civil judgment or order, county jurisdiction, state and

disposition of charges.

C Business bank accounts

1. The collection agency must have a bank account with at least $5,000 available for the use of the business.

(RCW 19.16.245)

Name of bank with at least $5,000 asset account Account number

Bank address Street or route, city, state, zip code

2. Each collection agency is also required to set up a "Customer's Trust Fund Account" for money that was collected on

behalf of clients and that is to be distributed to clients. (RCW 19.16.240)

Name of bank with trust fund account Account number

Bank address Street or route, city, state, zip code

D Client information

1. Do you currently have clients or plan to solicit businesses located in Washington State? ............ Yes No

2. Are you applying as a debt buyer?...................................................... Yes No

(See deﬁnition of client and debt buyer on page 2)

Upon ﬁling, this document and the application become a public record subject to public disclosure provisions.

(RCW 42.56)

For assistance or to request this document in an alternate format, visit http://business.wa.gov/BLS or call 1-800-451-7985. Teletype (TTY) users may call 360-705-6718.

BLS-700-335 (03/28/16)

Click here to START or CLEAR, then hit the TAB button

BLS-700-377 (04/14/16)

Deﬁnitions

Client: The business or person on whose behalf you will

collect claims.

Collection Agency Endorsement

Choose this endorsement if:

• YourmainofceisinWashingtonStateor

• YourmainofceislocatedoutsideWashingtonState,

andyouhave,orplantohave,clientsthatarelocated

inWashingtonState

Debt Buyer:Anypersonorentityengagedinthe

businessofpurchasingdelinquentorchargedoffdebtsfor

collectionpurposes,whetheritcollectsthedebtsitself,or

hiresathirdpartyforcollectionoranattorneyforlitigation

to collect the debts.

Out-of-State Collection Agency Endorsement

Choose this endorsement if:

• Yourmainofceandallbranchofcesarelocated

outsideWashingtonState,and

• YouhaveNOclientsthatarelocatedinWashington

State,and

• YouarecontactingdebtorsthatliveinWashington

State who owe money to your out of state clients.

Instructions

1. Select the correct endorsement and fee.

The type of endorsement you need is based on the

location of your clients. See Deﬁnitions above.

CollectionAgencyEndorsement..........................$850

CollectionAgencyBranchEndorsement..............$550

Out-of-StateCollectionAgencyEndorsement.....$425*

Out-of-StateCollectionAgency

BranchEndorsement...........................................$275*

* TheendorsementfeeforanOut-of-StateCollection

AgencyLicenseiswaivedifthestatewherethe

collectionagency(mainorbranchofce)islocated

requiresalicenseorregistrationbutdoesnotrequire

afeeforsimilarout-of-statecollectionagencies.To

have the license fee waived, include a copy of the

regulations from your home state.

2. Complete the following items and submit them

with your fee.

• BusinessLicenseApplication;

• CollectionAgencyAddendum(pageoneofthis

form);

• Personal/CorporateFinancialStatementformthat

shows:

• Theliabilitiesandassetsoftheagencyinoneof

the three months prior to application.

 Example:IfyouareapplyinginMay,wewill

acceptanancialstatementcompletedforthe

February,MarchorApriltimeperiods.

• $7,500ormoreincashoritsequivalent

• $5,000ofthecashmustbedepositedinabank

account used to operate the business.

• $7,500ormorenetworth.

• $5,000bondorcashdeposit**(intheformofa

cashier'scheckpayabletoStateTreasurer);and

• Listofpersonswithmorethan20%interestinthe

business.

** Abondisnotrequiredforanout-of-statecollection

agencyiftheagency'shomestatealreadyrequiresa

bondorsimilarlegalalternativeforcollectionagencies.

To waive the Washington bonding requirement,

enclose proof that your bond is current and a copy of

the regulations from your home state for review.