Declaration of Activity
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STATE OF WASHINGTON
DEPARTMENT OF FINANCIAL INSTITUTIONS
division of Consumer Services
P.O. Box 41200 ( Olympia, Washington 98504-1200
Telephone (360) 902-8703 ( TDD (360) 664-8126 ( FAX (360) 664-2258 (
Tax refund anticipation loan facilitators’
registration form
Instructions
1. Complete the form below (page 2).
2. Write a check payable to the “Washington State Treasurer” for $35.00 per EFIN. (For example, your main office has a unique EFIN. Three of your branch offices each have unique EFINs. Your website address has a unique EFIN. You have a total of five EFINs. Your registration fee is $35.00 x 5 = $175.00.)
3. Mail the completed form and your registration fee to:
Department of Financial Institutions
P.O. BOX 41200
Olympia, WA 98504-1200
Additional Offices
For additional offices, please use this form as many times as needed.
Questions? Contact Us.
|Phone |(360) 902-8703 |
|Toll-Free |1-877 RING DFI (746-4334) |
|Email |dcs@dfi. |
|Fax |(360) 664-2258 |
| | |
| | |
[pic]
STATE OF WASHINGTON
DEPARTMENT OF FINANCIAL INSTITUTIONS
division of Consumer Services
P.O. Box 41200 ( Olympia, Washington 98504-1200
Telephone (360) 902-8703 ( TDD (360) 664-8126 ( FAX (360) 664-2258 (
Tax refund anticipation loan facilitators’
registration form
|Company Name | |
|Trade Name | |
|Contact Person | |
|Physical Address | |
| City |
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|State |
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|Zip |
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|Mailing Address | |
| City |
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|State |
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|Zip |
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|Company Phone |( ) |
| | - |
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|FAX |( ) |
| | - |
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|Email | |
|Website (URL) | |
|E-File Provider | |
|Number (EFIN) | |
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