APPLICATION:  Answer all questions; attach additional sheets of paper as 
needed.

(1) 	NAME OF CREDIT SERVICES ORGANIZATION:

     	___________________________________________________________________

	ADDRESS(ES) WHERE BUSINESS IS CONDUCTED:

	___________________________________________________________________

	___________________________________________________________________

	MAILING ADDRESS (if different from above):

	___________________________________________________________________

	___________________________________________________________________

	TELEPHONE(S)

	___________________________________________________________________


(2) 	Date established:

(3)	Names, addresses and driver's license numbers of all persons who 	
	directly or indirectly own or control 10 percent or more of the 	
	outstanding shares of stock.















(4)	Names, addresses and driver's license numbers of those who have 
	management responsibilities.




















(5)	Names of all prior or current credit services organizations that any 
	persons identified in (3) or (4) above have been or are affiliated 	
	with.  Please state who had that affiliation what the nature of it 	
	was, and the time period for each such affiliation.









(6)	Do either of the following:

	(a)  Attach a complete description of any litigation commenced 	     	     
	     against the credit services organization or of any resolved or 	     
	     unresolved complaint, relating to the operation of the credit 	     
	     services organization, that was filed with the California 	     	     
	     Attorney General, any other governmental authority of 	     	     
	     California, any other state, or the federal government. With 	     
	     respect to each resolved complaint, please provide a brief 	     
      	     description of the resolution.

OR

	(b) Sign the following statement:

	I, _____________________________declare under penalty of perjury 	
	under the laws of the State of California that no litigation has 	
	been commenced and no unresolved complaint relating to the operation 	
	of this credit services organization have been filed with the 		
	California Attorney General, any other governmental authority in 	
	California, or any other state or federal government agency. This 	
	statement is executed on______________________.
                                                (date)





					_________________________________
					Signature

(7)	What method of advertising do you use?  Please check all that apply. 

        _____Television _____ Radio _____Newspaper _____Flyers

        _____Telephone Solicitation  _____ Other (please describe)

     	_____________________________________________________________

	_____________________________________________________________

	_____________________________________________________________


(8)	Provide the following documents, checking the appropriate spaces:

  	_____  Written transcript of all television or radio advertisements, 	       
	       copy of all print advertisemems, and description of any other 	       
	       advertising method to be used are attached.

	_____  Telephone scripts, sales presentations, and all other 		       
               instructional material provided to persons who speak with                   
               prospective buyers are attached.

	_____  Contract(s), separate notice of cancellation, Information                   
               Statement, all other documents provided prospective buyers,                 
               and all other documents a buyer is required to sign are 	                   
               attached.

	For any items that are not attached, state why such documents have 	
        not been provided:

	_________________________________________________________________

	_________________________________________________________________

	_________________________________________________________________






(9)     Check the appropriate space.

        _____ I have submitted a copy of the bond or deposit to the                       
              Secretary of State.

        _____ I have not submitted a copy of the bond or deposit to the 
	      Secretary of State. I will notify the Department of Justice                 
              when I have. I understand that this application will not be                 
              reviewed until confirmation of a properly filed bond or                     
              deposit is received.

YOUR REGISTRATION APPLICATION CANNOT BE PROCESSED UNTIL ALL THE INFORMATION 
AND ALL DOCUMENTS REQUIRED ABOVE HAVE BEEN PROVIDED.