Illinois Payday Lender License Application CheckList
- Application Form
- A copy of all organization documents is required to be filed with the Illinois Secretary of State and a copy of the filing of assumed business name with the appropriate County Clerk’s office if a sole proprietorship.
- “Supplemental Application” as provided in the application packet and credit report of:
- the proprietor, if the applicant is an individual
- every partner, if the applicant is a partnership
- the President, Secretary, Executive and Senior Vice Presidents, Directors, and individuals owning more than 25% of the corporate stock, if the applicant is a corporation; and
- the manager, if the applicant is a limited liability company
- Most recent year-end and quarter-end financial statements, or opening statements for new corporations, completed according to Generally Accepted Accounting Principals and certified by the original signature of the applicant, President, or manager of limited liability, or partner thereof. The balance sheet must contain only business-related items and demonstrate a net equity (total assets minus total liabilities) of $30,000.
- Original $50,000 Surety Bond in favor of the Director of the Division of Financial Institutions, signed and sealed by the applicant and Attorney-in-Fact of the bonding company.
- Appointment of Attorney-in-Fact for Service of Process
- Photographs of both the inside and outside of the proposed location
- Business Plan detailing the nature, amount, and term of loans to be made and types of security that will be taken
- A list of all states where the applicant is licensed to issue Payday Loans. If the said license has been withdrawn, refused, canceled, or suspended in any other state, please state the specifics surrounding this event
- Information Form as provided in the application packet
- A check in the amount of $1000 forwarded to the Illinois Department of Financial and Professional Regulation to serve as a license fee. Fees are not refundable.
- A request for authorization of any other business to be conducted at the licensed location
- If requesting an Other Business Authorization, please forward a separate check to the Illinois Department of Financial and Professional Regulation in the amount of $100 per Other Business Authorization (OBA) requested. NOTE: Only one OBA is issued to a company to cover all licensed locations. This fee is non-refundable.
Example Illinois Payday Loan License
Please return the completed application and related fees to the address list below:
Illinois Department of Financial & Professional Regulation
Division of Financial Institutions
Consumer Credit Section
100 W. Randolph St. Suite 9-100
Chicago, IL 60601
| Office Use Only
Log No.___________
Check #___________
Fee Slip__________ |
STATE OF ILLINOIS
DEPARTMENT OF FINANCIAL & PROFESSIONAL REGULATION
DIVISION OF FINANCIAL INSTITUTIONS
APPLICATION FOR PAYDAY LENDER LICENSE
PAYDAY LOAN REFORM ACT
Application is hereby made to the Director of Financial Institutions for a license to
engage in the business under the provisions of the Illinois Payday Loan Reform Act.
- Full Name of Applicant:_______________________________________________
- Proposed Licensed Location:________________________________________
(Address)
(City) (County) (State) (Zip Code)
- Corporate Address:__________________________________________________________________
(City) (State) (Zip Code)
- ( ) 5. ( )_______________________________
Telephone # Fax #
Contact Person Federal Employer I.D. #
- Type of Ownership: Sole Proprietorship , Partnership , Corporation , Limited Liability Company ,
Other____________________________________________________________________
- If the entity is a corporation, State of Incorporation:______________________________________
- Is applicant licensed to issue Payday Loans in any other State or Territory of the S.? ___________________
IF Yes, provide a list of the States.
- At any time has the applicant entity listed above had its license cancelled or suspended in any other State or Territory of the S.? _____________________
If Yes, provide full details on a separate sheet.
- At any time has the applicant ever had an application for a license to issue Payday Loans withdrawn or refused in any other State or Territory of the S.? ________________
If Yes, provide full details on a separate sheet.
If the entity is a foreign corporation, the date, and number of Charter in Illinois:
_________________
Date Number
Page 1 of 2
14.______ The Proposed site is not within one mile of a horse race track subject to the Illinois Horse Racing Act of 1975, within one mile of a facility at which gambling is conducted under the Riverboat Gambling Act, within one mile of the location at which a riverboat subject to the Riverboat Gambling Act docks, or within one mile of any State of Illinois or the United States military base or naval installation.
OR
______ The location was already in existence as a payday loan business as of June 1, 2005.
- Does the applicant/entity maintain any other licenses issued by the Department of
Financial and Professional Regulation? ____________
If YES, please list type of license and license number:
- Describe any other business that will be conducted at this location other than the business of making loans under the Payday Loan Reform Act.
under penalties of perjury, I declare that I have examined the application and all supporting documents submitted by me in connection therewith, and to the best of my knowledge, they are true, correct, and complete.
__________________
(Signature of Applicant) Date________
STATE OF ILLINOIS
DEPARTMENT OF FINANCIAL & PROFESSIONAL REGULATION
DIVISION OF FINANCIAL INSTITUTIONS
SUPPLEMENTAL APPLICATION PAYDAY LENDER LICENSE
All answers must be TYPED or legibly PRINTED. All questions must be answered.
- Individual’s Name:_______________________________________________________________
(First) (Middle) (Last)
- Corporate Title:_____________________________________
- Percentage of Ownership:_____________
- Date of Birth:_______________________
- Social Security Number:__________________________________________________________
- Business Address:________________________________________________________________
- Resident Address:________________________________________________________________
- Telephone Number:________________________________________________________________
- Business Experience for past ten (10) years in descending chronological
Order: (A copy of a resume for the same period of time may be substituted
to satisfy this requirement.)
Years______________________________________________________________________________
From To Company Name:_________________________________________________________
Company Address:______________________________________________________________________
Position Held:________________________________________________________________________
Principal Duties:_____________________________________________________________________
Years______________________________________________________________________________
From To Company Name:_________________________________________________________
Company Address:______________________________________________________________________
Position Held:________________________________________________________________________
Principal Duties:_____________________________________________________________________
Years______________________________________________________________________________
From To Company Name:_________________________________________________________
Company Address:______________________________________________________________________
Position Held:________________________________________________________________________
Principal Duties:_____________________________________________________________________
- In the past 10 years, have you ever been convicted of a felony?
Yes No_____
If yes, provide on a separate sheet full details, including a summary, the
the court, the presiding judge(s), and the title and document number.
- In the past 10 years, have you been a party to any material litigation?
Yes No_____
If yes, provide on a separate sheet full details, including a summary, the
court, presiding judge(s) and the title and document number.
Under penalties of perjury, I declare that I have examined the application and all supporting documents submitted by me in connection therwith, and to the best of my knowledge they are true, correct and complete.
__________________
(Signature of Applicant) Date
Page 2 of 2
STATE OF ILLINOIS
DEPARTMENT OF Financial & PROFESSIONAL REGULATION
DIVISION OF FINANCIAL INSTITUTIONS
LICENSEE BOND
Payday Loan Reform Act
KNOW ALL MEN BY THESE PRESENTS, That_____________________________________________________________
Corporate or Company Name
___________________________________________________________________________________
Street Address City/State
and,________________________________________________________________________________
as surety, are held and firmly bound unto the Division of Financial Institutions, for the use of the State and of any person or persons who may have a cause of action against the obligors of this instrument, under the provisions of the Act hereinafter described, in the penal sum of for the period from this date_________________________ to December 31, ________, for the payment of which, well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.
Witness our hands and seals this day of , A.D.______
The condition of the above obligation is such that the above
___________________________________________________________________________________
Corporate or Company Name has applied for a license for the term ending December 31, 20____, to transact the business of making loans in accordance with the provisions of the Illinois Payday Loan Reform Act.
Now, if the said______________________________________________________________________
Corporate or Company Name
shall, upon issuance of said license as aforesaid, faithfully conform to and abide by each and every provision of said Act and of all rules, regulations and directions lawfully made by the Director of Financial Institutions, and will pay to the State and to any person or persons from said obligors, under and by virtue of the provisions of said Act, then this obligation to be void, otherwise to remain in full force and effect.
___________________________________
Corporate or Company Name
By_________________________________
President, Owner or Partner
By_________________________________
Secretary, Owner or Partner
__________________________________
Surety or Bonding Company
By_________________________________
Illinois Attorney-in-Fact
(Attach Power of Attorney)
State of Illinois
Department of Financial & PROFESSIONAL REGULATION
DIVISION OF FINANCIAL INSTITUTIONS appointment of attorney-in-fact for service of process know all men by these presents:
that_____________________________________________________________________________________________
Corporate or Company Name
_________________________________________________________________________________________________
Street City
____ does hereby appoint the
County State
incumbent Director of the Division of Financial Institutions of the State of Illinois and his/her successors in office, or any official who shall hereafter be charged with the administration of the Payday Loan Reform Act, its attorney-in-fact upon whom all processes of law against it arising out of any transaction under the Payday Loan Reform Act may be served. The appointment of the Director of Financial Institutions as attorney-in-fact is conditional upon the issuing of a license to conduct a business of making loans under the Payday Loan Reform Act and in the event that a license is not granted, this appointment shall remain in full force and effect and may not be revoked except by consent of the Director of Financial Institutions. In the event that the license of said applicant is revoked, surrendered or otherwise terminated, the appointment of the Director of Financial Institutions as attorney-in-fact to accept service of process shall continue until such time as all matters arising out of the conduct of said licensee’s business in this state shall have been concluded.
IN WITNESS WHEREOF, the applicant has set his hand and seal in the City of State of ,
On 20
(CORPORATE SEAL) By__________________________________
(President, Owner, Partner)
By__________________________________
(President, Owner, Partner)
CORP. FILE NUMBER
IF OUT OF STATE
Subscribed and sworn to before me this day of 20_____
Notary Public My Commission Expires_______________________
NOTARY SEAL
INFORMATION FORM
- Name, Title, Percent of Stock Ownership and Resident Address of Every officer
of the Licensed Entity.
- _________________________________________________________________________
(Name) (Title) (Percent of Stock)
_________________________________________________________________________
(Address) (City) (State) (Zip Code)
- _________________________________________________________________________
(Name) (Title) (Percent of Stock)
_________________________________________________________________________
(Address) (City) (State) (Zip Code)
- _________________________________________________________________________
(Name) (Title) (Percent of Stock)
_________________________________________________________________________
(Address) (City) (State) (Zip Code)
(If more space is required attach a separate sheet)
- Name, Title, Percentage of Ownership and Resident Address of Each Director of
the Licensed Entity.
- _________________________________________________________________________
(Name) (Title) (Percent of Stock)
_________________________________________________________________________
(Address) (City) (State) (Zip Code)
- _________________________________________________________________________
(Name) (Title) (Percent of Stock)
_________________________________________________________________________
(Address) (City) (State) (Zip Code)
- _________________________________________________________________________
(Name) (Title) (Percent of Stock)
_________________________________________________________________________
(Address) (City) (State) (Zip Code)
(If more space is required attach a separate sheet)
III. Name, Percent of Ownership and Resident Address of Each Stockholder Owning
10% or More of Capital Stock or Any Owner/Partner of the Licensed Entity who
is Not Listed Above.
- _________________________________________________________________________
(Name) (Percent of Stock/Ownership)
_________________________________________________________________________
(Address) (City) (State) (Zip Code)
- _________________________________________________________________________
(Name) (Percent of Stock/Ownership)
_________________________________________________________________________
(Address) (City) (State) (Zip Code)
- _________________________________________________________________________
(Name) (Percent of Stock/Ownership)
_________________________________________________________________________
(Address) (City) (State) (Zip Code)
(If more space is required attach a separate sheet)
The Percentage of Ownership from Section I, II and III Must Total 100%
