DEPARTMENT OF CONSUMER
NYC SMALL BUSINESS
AFFAIRS (DCA) LICENSING CENTER
SUPPORT CENTER
42 Broadway, Lobby
90-27 Sutphin Blvd, 4th Floor
New York, NY 10004
Jamaica, NY 11435
Monday-Friday: 9:00 a.m.-5:00 p.m.
Monday-Friday: 9:00 a.m.-5:00 p.m.
Wednesday: 8:30 a.m.-5:00 p.m.
311 (212-NEW-YORK outside of NYC)
nyc.gov/dca | @NYCDCA
DEBT COLLECTION AGENCY – LICENSING NEW APPLICATION & RENEWAL
SUPPLEMENT
Instructions: You must provide current information for your business as requested in the boxes below and affirm that your responses
are true. For the purposes of this form, the terms “you” and “your” refer to the business entity applying for a license or renewal.
Applicant / Licensee Information:
Legal Name of Business
DCA License Number
(A).
:
(B).
:
(The Legal Name that you provide must be exactly as filed with the County Clerk or New York State Secretary of State)
(Fill in if you are renewing; leave blank if this is a new license
application)
Business Premises Address
(C).
:
(Building Number, Street Name, Unit, e.g., Floor, Suite)
City
State/Province
ZIP Code
Country
:
:
:
:
Telephone Number
Fax Number
Email
(D).
:
(E).
:
(F).
:
For the purposes of the questions below, the term “debt” is defined to have the meaning set forth in Section 20-489(d) of the New
York City Administrative Code: “The term ‘debt’ means any obligation or alleged obligation of a consumer to pay money arising out
of a transaction in which the money, property, insurance, or services which are the subject of the transaction are primarily for
personal, family, or household purposes, whether or not such obligation has been reduced to judgment, or any obligation or alleged
obligation arising out of a judgment or valid agreement for the payment of child support.”
YES
NO
1. Does your business contact consumers directly to
collect debt, including by mail or telephone?
(Contacts consumers
(Does not contact consumers
directly to collect debt)
directly to collect debt)
YES
NO
2. (a). Does your business purchase delinquent debt?
(Purchases delinquent
(Does not purchase
debt)
delinquent debt)
Applicant seeks to collect purchased debt directly.
(b). If you checked “YES” to part (a) of this
question, check the appropriate box to indicate your
Applicant seeks to collect purchased debt indirectly by
activities with respect to the purchased delinquent
debt. (Check only 1 box.)
contracting with others for collection services.
Applicant seeks to collect purchased debt both directly
and indirectly by contracting with others for collection
services.
YES
NO
3. Is your business a law firm or are you an attorney-at-
law?
(Business is a law firm or
(Business is not a law firm or
an attorney-at-law)
an attorney-at-law)
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Debt Collection Agency Licensing New Application & Renewal Supplement
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