Consent To Service Of Process - Tennessee Department Of Commerce & Insurance

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Debt Management Services Program
500 James Robertson Parkway
Nashville, TN 37243
Tel: 615-741-1831 • Fax: 615-253-1692
Consent to Service of Process
An applicant or registrant shall consent to jurisdiction of the State of Tennessee and the venue in Davidson County,
Tennessee.
State or Province of ________________________
County of __________________________
The undersigned _______________________________________, (a corporation), (a partnership)
organized under the laws of _____________________ or (an individual) [strike out inapplicable
nomenclature] personally appeared, for purposes of complying with the laws of the State of Tennessee
relating to the provision of Debt Management Services, irrevocably appoints the Commissioner of
Commerce and Insurance, so designated hereunder and his/her successors, its attorney in the State of
Tennessee; and the undersigned does hereby consent that any such action or proceeding against it may be
commenced in any court of competent jurisdiction and proper venue within the State of Tennessee by
service of process upon the Commissioner of Commerce and Insurance as if the undersigned was
organized or created under the laws of the State of Tennessee and have been served lawfully with process
in the State of Tennessee.
It is requested that a copy of any notice, process or pleading served hereunder be mailed to:
Name: ______________________________________________________________________
Mailing Address _____________________________________________________________
_____________________________________________________________
City
State
Zip Code
Sworn to and subscribed before me this _______________ day of __________________, 20___.
____________________________________
Notary Public
My Commission Expires: ______________
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