Applications, forms, and reports

Finance

• Banks & trusts
• Check-cashing businesses
• Collection agencies
• Consumer finance companies
• Credit services organizations
• Credit unions
• Debt consolidating agencies
• Endowment care
• Funeral and cemetery - Consumer Protection Fund
• Manufactured structures dealers
• Master trustees
• Money transmitters
• Mortgage lenders
• Pawnbrokers
• Prearranged funeral plans (preneed certified providers)

Securities

• Broker dealers
• Investment advisers
• Investor information program
• Securities registration

---

Portable document format (PDF): PDFs need to be printed first, then completed, and mailed to the Division for processing. If you are unable to open one, please download Acrobat Reader from Adobe.

MS Word (Word): If you have MS Word you can fill it in, print it, and mail it to the Division for processing.

Online fillable forms (On-line form): Form that can be filled out online, then submitted to the Division for processing.

---

Finance

---

Banks & trusts

Application for authority to organize a state bank 440-2208 last updated: 10/21/2008	PDF
Confidential biographical and financial report 440-2070 last updated: 03/08/2006	PDF  | Word
Designation of registered agent and/or office 440-4009 last updated: 03/08/2006	PDF
Public Records Request 440-4871 last updated: 11/13/2009	PDF
Request for a certificate of name compliance 440-4867 last updated: 10/22/2009	PDF  | Word
Special qualifications registration 440-2042 last updated: 12/15/2006	PDF
Trust company application 440-4008 last updated: 03/08/2006	PDF

---

Check-cashing businesses

Check-cashing annual report 440-4803 last updated: 05/22/2008	PDF  | Word
Check-cashing business initial license application (for businesses with a current consumer finance or pawnbroker license) 440-4770 last updated: 06/02/2008	PDF  | Word
Check-cashing business initial license application (for businesses without a current consumer finance or pawnbroker license) 440-4771 last updated: 06/02/2008	PDF  | Word
Public Records Request 440-4871 last updated: 11/13/2009	PDF

---

Collection agencies

Application form 440-2778 last updated: 07/17/2009	PDF  | Word
Public Records Request 440-4871 last updated: 11/13/2009	PDF

---

Consumer finance companies

Consumer finance and short-term personal loan initial license application 440-2789 last updated: 04/01/2008	PDF  | Word
Consumer finance and short-term personal loan license application for additional location 440-4027 last updated: 04/01/2008	PDF  | Word
Conventional loan licensee annual report 440-4818 last updated: 08/27/2008	PDF  | Word
Public Records Request 440-4871 last updated: 11/13/2009	PDF
Short-term loan licensee annual report 440-4817 last updated: 08/27/2008	PDF  | Word

---

Credit services organizations

Initial registration pack 440-2793 last updated: 09/08/2008	PDF  | Word
Public Records Request 440-4871 last updated: 11/13/2009	PDF
Renewal registration pack 440-2794 last updated: 03/08/2006	PDF  | Word

---

Credit unions

Branch application and checklist 440-2784 last updated: 05/12/2008	PDF  | Word
Bylaw amendment 440-2780 last updated: 05/17/2006	PDF  | Word
Change of location 440-2779 last updated: 03/08/2006	PDF  | Word
Change of registered office and/or agent 440-2781 last updated: 03/08/2006	PDF  | Word
Change to list of officials 440-2935 last updated: 03/08/2006	PDF  | Word
List of officials 440-2782 last updated: 03/08/2006	PDF  | Word
Model bylaws 440-2783 last updated: 03/08/2006	PDF  | Word
Public Records Request 440-4871 last updated: 11/13/2009	PDF

---

Debt consolidating agencies

Biennial renewal form 440-3364 last updated: 09/08/2008	PDF  | Word
Debt Consolidation Agency Registration Application 440-2799 last updated: 02/24/2009	PDF  | Word
Public Records Request 440-4871 last updated: 11/13/2009	PDF

---

Endowment care

Annual report - endowment care cemeteries 440-4016 last updated: 12/13/2007	PDF
Endowment Care for Burial Vaults and Markers Penal Bond with Surety 440-3375 last updated: 12/13/2007	PDF  | Word
Endowment Care for Crypts or Niches Penal Bond with Surety 440-3374 last updated: 12/13/2007	PDF  | Word
Public Records Request 440-4871 last updated: 11/13/2009	PDF

---

Funeral and cemetery - Consumer Protection Fund

Funeral and Cemetery Consumer Protection Trust Fund Annual Report 440-4013 last updated: 06/17/2008	PDF
Funeral and Cemetery Consumer Protection Trust Fund Claim for Restitution 440-4018 last updated: 07/08/2009	PDF

---

Manufactured structures dealers

Irrevocable Letter of Credit 440-3485 last updated: 02/13/2007	PDF  | Word
Limited Manufactured Structures Dealer License Application 440-2965 last updated: 11/30/2006	PDF  | Word
Manufactured Structures Dealer and Limited Manufactured Structures Dealer License Correction Application 440-2964 last updated: 12/01/2006	PDF  | Word
Manufactured Structures Dealer and Limited Manufactured Structures Dealer Surety Bond 440-2966 last updated: 11/30/2006	PDF
Manufactured Structures Dealer License Application 440-2962 last updated: 12/27/2006	PDF  | Word
Manufactured Structures Dealer Supplemental License Application 440-2963 last updated: 11/30/2006	PDF  | Word
Manufactured Structures License Report of Examination 440-3498 last updated: 06/12/2007	PDF  | Word
Public Records Request 440-4871 last updated: 11/13/2009	PDF

---

Master trustees

Annual report form for master trustee 440-4017 last updated: 12/13/2007	PDF
Application for master trustee 440-4012 last updated: 12/13/2007	PDF
Notice of appointment of successor depository or master trustee 440-3437 last updated: 04/11/2008	PDF  | Word
Public Records Request 440-4871 last updated: 11/13/2009	PDF

---

Money transmitters

Bond agreement 440-3274 last updated: 03/08/2006	PDF
Deposit in lieu of security device 440-4603 last updated: 03/08/2006	PDF
Initial application 440-3260 last updated: 11/06/2007	PDF  | Word
Public Records Request 440-4871 last updated: 11/13/2009	PDF
Renewal application 440-3265 last updated: 11/06/2007	PDF  | Word

---

Mortgage lenders

Affidavit and undertaking - no clients' trust account 440-2776 last updated: 06/01/2007	PDF  | Word
Change of name or address request 440-3919 last updated: 03/08/2006	PDF  | Word
Clients' trust account, notice of 440-2777 last updated: 03/08/2006	PDF  | Word
Examination - loan worksheet 440-3369 last updated: 03/08/2006	PDF  | Word
Examination report 440-3368 last updated: 08/31/2007	PDF  | Word
Foreclosure Notice last updated: 02/23/2009	PDF  | Word
Interest Rate Lock/Float Agreement 440-4828 last updated: 08/20/2008	PDF  | Word
Investor Disclosure Information 440-4827 last updated: 08/20/2008	PDF  | Word
Loan originator notification form 440-2772 last updated: 03/08/2006	PDF  | Word
Loan originator termination notification 440-2907 last updated: 03/08/2006	PDF  | Word
Mortgage lender application package 440-2773, etc. last updated: 06/28/2007	PDF  | Word
Mortgage Lender Report of Limited Examination 440-0949 last updated: 12/11/2008	PDF  | Word
New branch application 440-3910, etc. last updated: 03/08/2006	PDF  | Word
Nonprofit applying for mortgage lender licensing exclusion request 440-3457 last updated: 12/15/2006	PDF  | Word
Personnel Information Ledger 440-4826 last updated: 08/27/2008	PDF  | Word
Public Records Request 440-4871 last updated: 11/13/2009	PDF
Section 5 - Affiliated Person Information 2894 last updated: 03/08/2006	PDF  | Word
Surety bond form 440-2775 last updated: 06/28/2007	PDF  | Word

---

Pawnbrokers

Annual report form 440-3371 last updated: 03/08/2006	PDF  | Word
Application package 440-3232 last updated: 03/08/2006	PDF  | Word
Public Records Request 440-4871 last updated: 11/13/2009	PDF

---

Prearranged funeral plans (preneed certified providers)

Annual report - short form 440-4015 last updated: 03/08/2006	PDF
Annual report form for certified provider 440-4014 last updated: 04/01/2008	PDF
Application for certified provider 440-4011 last updated: 09/06/2006	PDF
Funeral and Cemetery Consumer Protection Trust Fund Annual Report 440-4013 last updated: 06/17/2008	PDF
Funeral/Cemetery Merchandise Delivered Inventory List 440-4813 last updated: 06/02/2008	PDF  | Word
Notice of appointment of successor depository or master trustee 440-3437 last updated: 04/11/2008	PDF  | Word
Public Records Request 440-4871 last updated: 11/13/2009	PDF

---

Securities Note: Several of the forms in this section are from the NASAA or SEC websites. While we make every effort to ensure these forms are current, you are encouraged to visit the NASAA website or the SEC website for these forms.

---

Broker dealers

Dual undertaking 440-2131 last updated: 03/08/2006	PDF
Form U-10 NASAA form last updated: 09/24/2007	PDF
Form U-4 NASAA form last updated: 05/18/2009	PDF
Form U-5 NASAA form last updated: 09/24/2007	PDF
Form U-5 Instructions NASAA form last updated: 09/24/2007	PDF
Oregon Broker-Dealer Affidavit 440-4861 last updated: 09/23/2009	PDF  | Word
Public Records Request 440-4871 last updated: 11/13/2009	PDF
Trade/assumed name 440-2774 last updated: 03/08/2006	PDF  | Word

---

Investment advisors

Dual undertaking 440-2131 last updated: 03/08/2006	PDF
Firm renewal 440-2306 last updated: 03/08/2006	PDF
Form ADV (Parts 1A & 1B, plus instructions) NASAA form last updated: 09/24/2007	PDF
Form ADV Part II Please visit the NASAA website for this form. last updated: 09/26/2007
Form U-4 NASAA form last updated: 05/18/2009	PDF
Public Records Request 440-4871 last updated: 11/13/2009	PDF
Salesperson renewal 440-2118 last updated: 03/08/2006	PDF  | Word
Surety bond 440-2014 last updated: 03/08/2006	PDF
Trade/assumed name 440-2774 last updated: 03/08/2006	PDF  | Word

---

Investor information program

Need a speaker? Call the investor information program

On-line form or PDF

---

Securities registration

Form D SEC form last updated: 09/25/2007	PDF
Form U-1 NASAA form last updated: 09/24/2007	PDF
Form U-4 NASAA form last updated: 05/18/2009	PDF
Form U-4 Instructions last updated: 11/14/2007	PDF  | Word
Oregon form 440-2013 last updated: 06/26/2006	PDF  | Word
Proceeds Escrow Agreement 440-3517 last updated: 11/14/2007	PDF
Salesperson renewal 440-2118 last updated: 03/08/2006	PDF  | Word
Stock Escrow Agreement 440-3438 last updated: 11/14/2007	PDF