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APPLICATION FOR REGISTRATION AS A RETAIL GROCERY STORE CHECK CASHER

PART 1

The Pennsylvania Department of Banking and Securities (“the Department”) welcomes your request for this Retail Grocery Store Check Casher application. This portion of the application provides general information that will be of value to you when you complete the written portion of the application.

The Department issues Retail Grocery Store Check Casher registrations under the provisions of the Check Casher Licensing Act, which sets forth requirements both to become and to remain registered. The Department is responsible for registration provision of the Check Casher Licensing Act.

It is imperative that you become familiar with the Check Casher Licensing Act and the regulations issued thereto. You may wish to consult with an attorney. The legal citation for the Check Casher Licensing Act is 63 P.S. §§ 2301-2334 and is available on the Department’s website at www.dobs.pa.gov. Regulations are found within Title 10, Pennsylvania Code, Chapter 81, which is also available on the Department’s website.

Registration Required

Section 1101 of the Check Casher Licensing Act. A retail food store licensed as a public eating or drinking place, as defined by section 1 of the Public Eating and Drinking Place Law, that receives less than 1% of its annual gross revenue from cashing checks, must register annually with the Department.

A retail grocery store check casher is subject to the provisions of sections 301(b)(4), 304(c)(3), 503, 507 and 509 of the Check Casher Licensing Act.

Restrictions

Section 505 of the Check Casher Licensing Act. No check casher shall at any time cash or advance any money on a postdated check. No check casher shall engage in the business of transmitting money or receiving money for transmission, unless licensed under the Money Transmitter Act – Act 129.

Refer to Section 503 of the Check Casher Licensing Act for allowable fees and charges for cashing a check.

Retail Grocery Store Check Casher Registration Revised 7/2019

http://www.dobs.state.pa.us/

https://www.dobs.pa.gov/Documents/Statutes/Check%20Casher%20Licensing%20Act.pdf

http://www.dobs.pa.gov/

Annual registration fees; renewals

Section 1101 of the Check Casher Licensing Act. A fee of $100 must accompany the application for registration. Checks or money orders should be made payable to the Pennsylvania Department of Banking and Securities. By regulation, there can be no abatements granted on registration fees for registrations issued after the start of the May 1 registration year. If a registration is surrendered,revoked, or suspended prior to its expiration date, the registration fee cannot be refunded in whole or in part.

An annual fee of $100 must accompany renewal registrations. The renewal registration shall be effective from May 1 or upon the Department’s issuance of written notification that the entity has been registered by the Department as a retail grocery store check casher, whichever is later, through April 30 of the following year.

Other provisions that apply; other laws that may apply

The preceding discussion does not represent a complete analysis of the Check Casher Licensing Act. You are strongly advised to read and review the Check Casher Licensing Act along with Title 10, Pennsylvania Code, Chapter 81 and comply with all provisions when conducting business.

Information about corporate and business registration can be obtained by contacting the Corporation Bureau of the Pennsylvania Department of State, 3rd Floor, North Office Building, Harrisburg, Pennsylvania 17120-0029. The telephone number is (717) 787-1057, TT/Voice 1-800-679-5070 or visits their website at www.dos.pa.gov. An attorney should be able to advise you about federal laws that apply to retail check cashers.

How and Where to file

Please complete Part 2 of this application. Make a copy for your records. Mail the original and any required attachments, along with a check or money order in the proper amount, to the following address:

Pennsylvania Department of Banking and Securities Non-Depository Licensing Office 17 N 2nd St, Ste 1300 Harrisburg, Pennsylvania 17101-2290

Keep Part 1 for your records, as well as the copy of the Check Casher Act.

If you have any questions, please call the Non-Depository Licensing Office weekdays from 8:30 a.m. to 5:00 p.m. at (717) 787-3717, TT/Voice 1-800-679-5070 or visit our web site at [email protected].

We look forward to processing your application.


http://www.dos.pa.gov/

http://[email protected]

RETAIL GROCERY STORE CHECK CASHER APPLICATION

Part 2

For Official Use Only Registration #

1. Please indicate name of business and how it is structured.

How is business organized?

Name of entity:

D/B/A [if applicable]:

Federal ID Number ( Sole Prop Use Social Security Number):

Attach Articles of Incorporation, if a foreign corporation, Foreign Registration Statement to do business in Pennsylvania, or a copy of the Operating Agreement, By-Laws, etc., evidence of registry with the Pennsylvania Department of State, if required [if not required, state reason below] and, if applicable, a copy of the fictitious name registration. Please provide legal opinion if claiming exemption


Web address must be registered with the Pennsylvania Department of State if it is significantly different from the licensed name or the licensed name is not prominently displayed on the home page.

List all types of business offered on your website:

Explain how business will be conducted via the internet (if applicable):

2. List complete address(es) where check cashing business will be conducted.

OFFICIAL LOCATION ($100 LICENSING FEE MUST ACCOMPANY APPLICATION):

Street Address:

Zip:

Suite or Room #

State:

Branch Manager:

Fax Number:

City:

County:

Telephone Number:

If any of the following are not applicable, please indicate N/A

Company email address:Company web address:


Attach additional sheets if necessary

3. Information about officers, directors, owners, partners or members and any managers of the entity.

Cell Phone:

Full Name:

State:

Email Address:

Zip:

Zip:

List full name, corporate or official title in the business, residence address, residence telephone number, cell phone numberand email address of each officer, direct owner, director, partner or members and any managers of the proposed licensedbusiness.. Attach additional sheets if necessary.

Full Name: Title:

Street Address:

City: State: Zip:

Cell Phone: Email Address:

Full Name: Title:

Street Address:

City: State: Zip:


Full Name: Title:

Street Address:

City: Zip:


Title:

Street Address:

City:

Full Name:

Cell Phone:

State:

Email Address:

City:

Street Address:

Title:

State:


4. Please complete the following information to identify the person(s) the Department should contact to addresslicensing, consumer complaint, billing, compliance and examination concerns.

A. Licensing Contact:

Title:

State: Zip:

Office Fax:

Full Name:

Address:

City:

Office Phone:

B. Consumer Complaint Contact:

Title:

State: Zip:

Office Fax:

Full Name:

Address:

City:

Office Phone:

C. Billing Contact:

Title:

State: Zip:

Office Fax:

Full Name:

Address:

City:

Office Phone:

D. Compliance Contact:

Title:

State: Zip:

Office Fax:

Full Name:

Address:

City:

Office Phone:

E. Examination Contact:

Full Name: Title:

Address:

City: State: Zip:

Office Phone: Office Fax:

Email Address:

Email Address:

Email Address:

Email Address:

Email Address:


sdick

Rectangle

No Yes – please attach proof

No Yes – please attach proof

The applicant corporation, in pursuance of action taken at a regular meeting of the Board of Directors of said corporation does hereby appoint:

FULL NAME:

ADDRESS:

Telephone Number:

its true and lawful attorney and authorized agent upon whom all lawful process in any proceeding against it may be served and agrees that service of process on its attorney or agent herein named shall be of the same legal force and validity as if served upon it, the said corporation, and the authority for such service of process shall continue in force as long as any liability remains outstanding against it in the Commonwealth of Pennsylvania.

In the case of death, removal from the Commonwealth of Pennsylvania, or any legal disability or disqualification of its attorney or agent herein named, the said corporation does hereby appoint the Secretary of Banking and Securities of the Commonwealth of Pennsylvania, and successor in office, to be its true and lawful attorney and authorized agent upon whom all lawful process in any proceeding against it may be served and agrees that service of process on the Secretary of Banking and Securities shall be of the same legal force and validity as if served upon it, the said corporation, and the authority for such service of process shall continue in force as long as any liability remains outstanding against it in the Commonwealth of Pennsylvania.

5. Are you a Retail Food Store licensed/registered as a food establishment as defined in Section 2of the Food Act (P.L. 421, No 70)?

6. Are you a Retail Food Store licensed/registered as a public eating or drinking place asdefined in Section 1 of the Public Eating and Drink Place Law (P.L. 926, No. 369)?

9. Designate Pennsylvania Agent for Service of Process (for foreign entities only).

8. Total Gross Revenue for cashing checks for the last calendar year?

7. Gross Income Revenue for the last calendar year?


I understand by submitting this Retail Grocery Store Check Casher Application:

I am agreeing to be bound by the following declaration: "I declare that all of my answers on this Registration Application are complete, true and correct. I make this declaration subject to the penalties of 18 PA.C.S. § 4904 relating to unsworn falsification to authorities."

I attest that I have read and understand the following (click each link):

1.) Check Casher Act.

2.) Title 10, Pennsylvania Code, Chapter 81

Authorization/Affirmation


Owner, Officer or Partner:

Title:

Name:

Name: Title:

Signature:

Title:

Name:

Signature:

Signature:

Signature:

Title:Name:

https://www.dobs.pa.gov/Documents/Statutes/Check%20Casher%20Licensing%20Act.pdf

https://www.pacode.com/secure/data/010/chapter81/chap81toc.html

Have you...

Answered all questions or indicated N/A? Checked answers for accuracy? Authorized/Affirmed the application? Attached a copy of the Articles of Incorporation, Operating Agreement and/or Foreign Registration Statement? Attached a copy of the approved fictitious name registration if applicable? Made and retained a copy of the entire application for your records? Enclosed a check for the appropriate amount?

PENNSYLVANIA DEPARTMENT OF BANKING AND SECURITIES NON-DEPOSITORY LICENSING OFFICE 17 N 2ND ST, STE 1300 HARRISBURG, PA 17101-2290

10. Please review before mailing this application.

11. Please mail completed application and all required documentation to:
