Form Sr Application For Renewal Of License Pursuant To The Sale Of Checks Act - Alabama Securities Commission

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FORM SR
(To be left blank by all Applicants)
Name _________________________________
License No. _______________________________
Location _______________________________
Date Issued _______________________________
Classification ___________________________
License Fee Received _______________________
(To be filled in by all Applicants)
APPLICATION FOR RENEWAL OF LICENSE PURSUANT TO
THE SALE OF CHECKS ACT
To: STATE OF ALABAMA
Date ___________________________
Alabama Securities Commission
PO Box 304700
Montgomery, AL 36130-4700
401 Adams Ave, Suite 280
Montgomery, AL 36104
The undersigned hereby makes application for the renewal of a license under the provisions of the
Sale of Checks Act, Act No. 177, Ala. Code Section 8-7-1, et. at to engage in the business of selling,
issuing or otherwise dispensing checks, drafts, money orders or other instruments for the transmission or
payment of money and/or the business of receiving money as agent for obligors fo r the purpose of paying
such obligors' bills, invoices or accounts in the State of Alabama. For the purpose of such renewal
application, the undersigned submits the following information:
1.
The name of the Applicant is
2.
The address of the Applicant’s principal office in the State of Alabama is:
(street)
(city)
(county)
(state)
(zip)
3.
If a foreign corporation, the address of the principal office of the corporation is:
(street)
(city)
(county)
(state)
(zip)
4.
The trade name(s) under which the Applicant proposes to operate, if any, is:
1

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