State of Utah
DEPARTMENT OF COMMERCE DIVISION OF CONSUMER PROTECTION

TELEMARKETING PERMIT APPLICATION FORM

OFFICE USE ONLY Date Permit Issued:_______________ Permit Number: _________________

Annual Application Fee: $250.00 (Non-refundable)

Approved: ______________________ Denied: _________________________ Expiration:______________________

_________________________________________________________ (This is the name of institution that is registering.)

___________________________________________________________ Date of Application

Please mark the appropriate box:

[ ] INITIAL APPLICATION

[ ] RENEWAL APPLICATION

If you have any questions, please contact the Division at (801) 530-6601. Please make Application fee check or money order payable to the State of Utah. Please return the completed Application form and check or money order to: Department of Commerce Division of Consumer Protection 160 East 300 South, Second Floor PO Box 146704 Salt Lake City, Utah 84114-6704

Nov 2009

1.

Applicant’s Name: ______________________________________________________________________

2.

Applicant’s address:

__________________________________________________________________ Street ____________________________________________________________________ City State Zip Code ________________________________ _________________________________ Telephone Number Facsimile Number Telephone Number: _______________

3.

Contact Person: _______________________________________

____________________________________________________________________ Street ____________________________________________________________________ City State Zip Code

4.

Applicant’s previous business address(es) during the past ten (10) years.

____________________________________________________________________________________________ Zip Code Address City State ____________________________________________________________________________________________ Address City State Zip Code ____________________________________________________________________________________________ Zip Code Address City State 5. List all other names that Applicant does business under, (if none, please state):

____________________________________________________________________________________________ City State Zip Code Name Address (if different) ____________________________________________________________________________________________ Name Address (if different) City State Zip Code ____________________________________________________________________________________________ Name Address (if different) City State Zip Code 6. Surety requirement.

a. Please mark the appropriate box indicating the type of surety being provided in satisfaction of U.C.A. §13-26-3. [ ] Bond [ ] Letter of Credit [ ] Certificate of Deposit

NOTE: Utah Code Annotated § 13-26-3 (i ) states: “If neither the telephone soliciting business nor any person affiliated with the telephone soliciting business at the time of application has been found in an administrative, civil, or criminal proceeding within three years of the application to have violated this chapter the amount shall be $50,000; If the telephone soliciting business or any currently affiliated person has violated this chapter within three years preceding application the amount shall be $75,000.” A bond, certificate of deposit or letter of credit must be kept in force for one year after the Applicant notified the Division in writing that the Applicant has ceased all telemarketing or related activities.

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b.

If a bond is being submitted, please indicate the following: Amount of bond, letter of credit or certificate of deposit: Date of bond: __________________________ Bond expires: _________________________________

Name of Surety Company: ________________________________________________________________ Address of Surety Company: ______________________________________________________________ Telephone and fax number of Surety Company: _______________________________________________ Registered on Treasury list: [ ] Yes c. [ ] No

If a letter of credit or certificate of deposit is being submitted, please indicate the following: Date of letter of credit: _____________________ Date of certificate of deposit: _______________ Letter of credit expires: _____________________ Certificate of deposit expires: ________________

Name of Utah Bank: ____________________________________________________________________ Address of Utah Bank: ___________________________________________________________________ Telephone and fax number of Utah Bank: ____________________________________________________

7.

List the following information for all officers, directors, members, principals, and/or key employees (attach additional sheets if necessary). Name: __________________________________________________________________________________ Home Address: ___________________________________________________________________________ Street __________________________________________________________________________ Zip Code State City ____________________________________ ___________________________________ Facsimile Number Home Telephone Number ____________________________________ ___________________________________ Social security number Birth date and birth place Name: __________________________________________________________________________________ Home Address: ___________________________________________________________________________ Street __________________________________________________________________________ Zip Code City State ____________________________________ ___________________________________ Facsimile Number Home Telephone Number ____________________________________ ___________________________________ Social security number Birth date and birth place

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Name: _________________________________________________________________________________ Home Address: __________________________________________________________________________ Street __________________________________________________________________________ State Zip Code City ____________________________________ ___________________________________ Facsimile Number Home Telephone Number ____________________________________ ___________________________________ Social security number Birth date and birth place

8.

List all valid licenses or permits issued in Applicant’s name (include license numbers, dates of license, expiration dates and the state or other agency which issued the license):

____________________________________________________________________________________________ ____________________________________________________________________________________________

9.

List any work cards, business licenses or trade licenses revoked, suspended or cancelled for any reason (include agency, date of license and reason):

____________________________________________________________________________________________ ____________________________________________________________________________________________

10. Has any officer, director, member, principal, and/or key employee ever been convicted of racketeering or any offense involving fraud, theft, embezzlement, fraudulent conversion of property, misappropriation of property or other similar crimes: [ ] No [ ] Yes If “yes”, explain when and where conviction occurred, nature of conviction, and status of case (including court name and docket number). ____________________________________________________________________________________________ ____________________________________________________________________________________________

11. Has any officer, director, member, principal, and/or key employee had a final judgment or order, including stipulated judgment or order, in any civil or administrative action involving racketeering fraud, theft, embezzlement, fraudulent conversion of property or misappropriation of property, the use of any misleading or untrue representation in any attempt to sell or dispose of real or personal property, or the use of any unfair or deceptive trade practice? [ ] Yes [ ] No If “yes”, explain when and where the judgment or order was entered, nature of the judgment or order, and status of case (including court name and docket number). ____________________________________________________________________________________________ ____________________________________________________________________________________________ 4

12. Is any officer, director, member, principal, and/or key employee currently the subject of any injunction or any other order relating to a business activity as a result of any action brought by a federal, state, or local agency, including any action affecting any license to do business or practice any trade or occupation? [ ] No [ ] Yes

If “yes”, explain when and where the injunction or other order was entered, nature of the injunction or other order, and status of case (including court name and docket number). ____________________________________________________________________________________________ ____________________________________________________________________________________________

13. State the address for each location where telephone numbers are to be dialed and give the name and telephone number of the contact person for each location. __________________________________________________ Contact person _____________________________________ Telephone number

__________________________________________________________________________________________ State Zip Code Address City __________________________________________________ Contact person _____________________________________ Telephone number

__________________________________________________________________________________________ State Zip Code Address City __________________________________________________ Contact person _____________________________________ Telephone number

__________________________________________________________________________________________ State Zip Code Address City

14. Provide all of the telephone numbers used at each location: __________________________________________________ Location address _____________________________________ Telephone number _____________________________________ Telephone number _____________________________________ Telephone number _____________________________________ Telephone number _____________________________________ Telephone number _____________________________________ Telephone number _____________________________________ Telephone number _____________________________________ Telephone number _____________________________________ Telephone number _____________________________________ Telephone number

__________________________________________________ Location address

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15. Provide the following information for Applicant’s Registered Agent: __________________________________________________________________________________________ Name __________________________________________________________________________________________ Street Address __________________________________________________________________________________________ City State Zip Code ___________________________________________ _____________________________________________ Telephone Number Facsimile Number NOTE: The registered agent authorized by the Applicant to receive service of process must reside in this state. The failure of an Applicant to designate an agent to receive service or the failure to appoint a successor to the agent shall result in suspension of the registration or a denial of an initial or renewal registration. 16. If you are a 3rd party provider, list the name of the companies that you solicit on behalf of. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

17. List the goods or services that are to be the subject of Applicant’s telephone solicitation (i.e. vacation travel, credit card services, etc.): __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

18. Provide copies of the following (application is not complete without providing these copies): a. All telephone scripts to be utilized in the state of Utah. The telephone script(s) are to include the following: - A three day right to cancel that is from the date of the receipt of the merchandise or premium, whichever is later. - Your company’s refund policy after the three day right to cancel ends. - The instructions provided to purchasers on how they may exercise their right to cancel.

-

Highlight this information in the telephone script submitted to the Division. Please reference page six (6) of the application.

b.

Initial applicants only – Articles of Incorporation or other organizational documents that show Applicant’s current legal status.

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NOTE: According to the Telephone Fraud Prevention Act, UCA §13-26-11(1)(f) it is unlawful for a solicitor to fail to orally advise a purchaser at the time of the solicitation of the purchaser's right to cancel. Therefore, your script must include notice of the right to cancel in substantially the following form: “In addition to any right to otherwise revoke an offer, you, the purchaser, may cancel this sale up to midnight of the third business day after the receipt of the merchandise or premium, whichever is later.”

By signing this application, the undersigned certifies that the information provided herein is true and correct.

DATED: ____________________________

APPLICANT:

BY _______________________________________ ITS

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_________________________ (Surety’s Name) _________________________ _________________________ _________________________ (Surety’s Address and Telephone No.) SURETY BOND

Bond No. _____________

1. KNOW ALL PERSONS BY THESE PRESENTS, that we, __________________ , as Principal, and ____________________________________ a corporation of the State of ________________having its principal office at _____________________ duly licensed with the Utah Department of Insurance, as Surety, are held and firmly bound to the Division of Consumer Protection of the Department of Commerce of the State of Utah in the sum of _____________________________ Dollars ($__________), for the payment of which said Principal and Surety hereby bind themselves, their heirs, administrators, executors, successors, and assigns, jointly and severally, to pay said sum. 2. THE CONDITIONS OF THIS BOND are such that the Principal, _______________________, seeks to obtain a license from or registration with, the Division of Consumer Protection, State of Utah, to carry on business as ________________________. That business is subject to the laws of the State of Utah and the administrative rules adopted thereunder. 3. THEREFORE, if the Principal, [Registrant], shall during the period beginning on _____ day of _________, 20 ___ and ending on ______ day of ____________, 20 ___, faithfully observe and honestly comply with the provisions of all statutes and rules of Utah law applicable to the Principal’s business, and shall indemnify the Division of Consumer Protection and all consumers as set forth in those laws, then this obligation shall become void and of no effect, otherwise to remain in full force and effect. 4. IT IS UNDERSTOOD AND AGREED that this bond may be renewed from year to year by continuation certificate executed by said Surety, and that regardless of the number of years this bond remains in effect or the number of times it is renewed, in no event shall the Surety be liable for an amount exceeding the sum set forth above. It is also understood and agreed that the Surety may at any time, with thirty days written notice to the Division of Consumer Protection, terminate its liability herein, except that the Surety shall be liable for any losses occurring while this bond is in full force and effect. SIGNED AND DATED this ______ day of ______________, 20____. _______________________________ (Type or Print Surety’s Name) By:____________________________ Its: _______________________________ (Type or Print Principal’s Name) By: ____________________________ Its:

06/2010