REGISTRATION

* Denotes required fields

Organization Information

Organization Legal name (Issuer/Filer/Applicant)

State of Formation/Incorporation (State of Birth)

Date of Formation/Incorporation (Date of Birth)

TIN (EIN, ITIN, or SSN)

NMLS ID

CRD Number

Please note: Organization name refers to the applicant, issuer or filer. It is not the authorized representative filing on their behalf.

Street address 1

Street address 2

City

State

ZIP/Postal Code

Country

Phone

Has this organization ever filed with the Department of Financial Protection and Innovation (or with the former Department of Business Oversight)?	Yes No
If yes, please enter an Organization ID, license number, file number or package number:
Has this organization ever filed under a previous name?	Yes No
If yes, please provide previous name(s):
Are you registering to file a Securities/Franchise filing?	Yes No
Are you a Broker Dealer? Please enter your CRD number above before submitting.	Yes No
- If you are an Investment Adviser, please make your updates through FINRA.
Are you a California Finance Lender?	Yes No
Are you a California Residential Mortgage Lender?	Yes No
Are you a Check Seller, Bill Payer, or Prorater?	Yes No
Are you a Deferred Deposit Originator (commonly known as a Payday Lender)?	Yes No
Are you an Escrow Agent?	Yes No
Are you a Student Loan Servicer?	Yes No
Are you currently licensed as a Student Loan Servicer with the CA DFPI?	Yes No
Are you a PACE Program Administrator?	Yes No
Are you currently licensed as a Debt Collector with the CA DFPI?	Yes No
Are you currently a covered person registered under CCFPL with the CA DFPI?	Yes No

Authorized Representative

Representative Company Name (e.g. Law Firm)

Contact Person

First name

Last name

Street address 1

Street address 2

City

State

ZIP/Postal Code

Country

Phone

User Information

Username

(You will use this information to access your application or filing.)
Username should not contain spaces or the ampersand (&) symbol

Password

Must be a minimum of 8 characters and at least one number

Confirm Password

Security Question

(The Security Question and Answer are used for verification purposes when retrieving a lost password.)

Security Answer

The Department will process your registration within five business days. If you do not receive a confirmation email by that date, please check your "spam" folder or attempt to log in using the username and password you provided. Please contact toll-free (866) 275-2677 or (916) 445-7205, or email Ask.DFPI@dfpi.ca.gov with any questions. By submitting this form you are consenting to receive email notifications from the DFPI.