Form Cacl 280.151 - Facing Page For Application For A License Under The Capital Access Company Law
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10(Department of Corporations Use Only)
DEPARTMENT OF CORPORATIONS
Fee Paid $ ___________________
File No.__________________________
Receipt No. __________________
STATE OF CALIFORNIA
DEPARTMENT OF CORPORATIONS
FACING PAGE
FOR
APPLICATION FOR A LICENSE UNDER THE
CAPITAL ACCESS COMPANY LAW
PRE-LICENSE AMENDMENT NO. _________________
POST-LICENSE AMENDMENT NO. ________________
The application must be TYPEWRITTEN and accompanied by an application fee of $1,400. The
application (together with the fee payable to the Commissioner of Corporations) must be filed only in
the Sacramento Office of the Department of Corporations.
Special Instructions: Any amendment to this application for licensure under the Capital Access
Company Law shall be made by a verified pre-license or post-license amendment to the application. A
pre-license amendment is required for an amendment to the application prior to licensure; a post-license
amendment is required subsequent to licensure. An amendment is made by filing the completed
“Facing Page” with the appropriate pre-license or post-license amendment number entered, attaching the
pages of that part of the application (including the exhibits) that are revised or changed, and attaching
another duly executed and verified “Execution Page”. (The Execution Page is found at the end of this
application.)
1.
Name of Applicant: ________________________________________________________
Fictitious Business Name: __________________________________________________
2.
List the place or places of business at which Applicant will engage in licensed activity. Indicate
principal place of business and branch or other office locations: (Attach a separate sheet, if
necessary.)
___________________________________________________________________________
(Number and Street)
(City)
(County)
(State)
(Zip)
_____________________________________
___________________________________
(“d.b.a.” or fictitious business name)
(Name of person in charge of business location)
3.
Applicant is organized and will do business as (check as applicable):
[ ] a corporation
[ ] a limited liability company
[ ] a partnership
[ ] a limited partnership
[ ] trust
[ ] other (please specify) _______________________
[The application continues on the following, separate pages.]
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CACL 280.151
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