Notice Of Collections Manager Change Form - State Of Colorado - Department Of Law Page 2
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4STATE OF COLORADO
ADMINISTRATOR
COLORADO FAIR DEBT COLLECTION PRACTICES ACT
Email:
Tel: (720) 508-6020
car@coag.gov
COLLECTIONS MANAGER FORM
OMISSIONS MAY BE CONSTRUED AS INTENTIONAL FAILURE TO DISCLOSE A MATERIAL
FACT AND MAY BE SUFFICIENT GROUNDS FOR DENIAL OF APPLICATION.
1.
Collection Agency Name
2.
Collection Agency License #
3.
Collections Manager Name
4.
Home Address
(Street Address)
(City)
(State)
(Zip)
5.
Direct Telephone No. _________________________
Email
_
6.
Date of Birth ____________________________ Social Security No.
7.
Occupational Record: Furnish a complete record of employment or business association for
the last six (6) years, including all companies in which you have an interest as an officer,
director, voting stockholder, member or partner. Account for all periods of time, including
unemployment: (or attach a detailed resume showing your employment history)
(Month-Year)
FROM
TO
EMPLOYER
ADDRESS
POSITION
DUTIES
8/9/17
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