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Home | For Businesses | Creditor/Assignee Notification | Creditor/Assignee Notification Online Form

Creditor/Assignee Notification Form

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Creditor/Assignee Information

Notification and Volume Fee Calculation

Effective July 1, 2017, the Creditor/Assignee notification fee increased to $50.00. The calculation of volume fees remains the same.

Notice: This system does not allow payment via credit card. The online payment option requires filers to enter bank account information to establish an automatic debit. If you do not want to pay online, select the Creditor/Assignee Notification Printable Form and submit it along with your payment.

Company Information

Company Name:

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Address of Primary Office:

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City:

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State:

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Zip Code:

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Phone Number:

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Addresses of all offices or retail stores (if any) in Iowa where consumer credit transactions are entered into or acts, practices or conduct involving consumer credit transactions are engaged in. In the case of assignees, list any offices or places of business in Iowa at which business is transacted.

Location 2 Address:

City:

State:

Zip Code:

Location 3 Address:

City:

State:

Zip Code:

Name(s) under which business is conducted (DBAs)::

Name of Iowa Registered Agent:

Registered Agent Address:

City:

State:

Zip Code:

Attachments (if any):

Accepted Formats: Text Files, Word Documents, Excel Documents, PDFs

Attachments (if any):

Accepted Formats: Text Files, Word Documents, Excel Documents, PDFs

Attachments (if any):

Accepted Formats: Text Files, Word Documents, Excel Documents, PDFs

Business Contact Information

In the event that our office receives a complaint regarding your business, please provide the appropriate contact person.

Contact Name:

*

Address:

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City:

*

State:

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Zip Code:

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Phone Number:

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Fax Number:

Email Address:

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Name of Person Completing Form:

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Your Phone Number:

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Your Email Address:

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Contact Information

Iowa Attorney General
Consumer Protection Division
Attn: Notification & Fees Administrator
1305 E. Walnut Street
Des Moines, Iowa 50319

Email: registration@ag.iowa.gov

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