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Home | For Businesses | Debt Collector Notification | Debt Collection Notification Online Form

Debt Collection Notification Online Form

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Effective July 1, 2017, the notification fee increased to $50.00.

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 Debt Collection 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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Company Locations

Please list the addresses for any additional company locations where debt collection occurs (branches, etc.).

Location 2 Address:

Location 2 City:

Location 2 State:

Location 2 Zip Code:

Location 3 Address:

Location 3 City:

Location 3 State:

Location 3 Zip Code:

If more space is needed, please list additional comany locations:

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

Name of Iowa Registered Agent:

Address:

City of Iowa Registered Agent:

State of Registered Agent:

Zip Code of Registered Agent:

Attachments (if any):

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

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Company Contact

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

Contact Name:

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Contact Address:

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City of Company Contact:

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State of Company Contact:

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Zip Code of Company Contact:

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Contact Phone Number:

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Fax Number:

Email Address:

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Applicant Information

Name of Person Completing This Form:

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Your Email Address:

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Phone Number:

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Each person or firm who files a notification shall pay the administration an annual fee of $50.00.
Please make checks payable to: Iowa Consumer Credit Administration Fund.

Persons who fail to pay the required fees in full within thirty (30) days of due date, January 31st, will be assessed a $75.00 late charge [Iowa Code §537.6203(4)].

The administrator may bring a civil action against a person for failure to file notification or to pay fees under the above provisions [Iowa Code §537.6113(3)].

I declare that this filing has been examined by me and is, to the best of my knowledge and belief, true, correct, and complete:

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Full name of owner, officer, or partner

Title of Signee:

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Date:

Filing for the first time:

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Yes, this is the first time filing this.

No, I have filed this report before.

Please submit the completed form and annual fee no later than January 31 to:

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

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