Money Services Business Registration Form

Money Services Business Registration Form
Register your business to provide money services. Please complete all sections accurately.
Business Legal Name
Business Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Primary Contact Full Name
First NameLast Name
Primary Contact Email Address
example@example.com
Primary Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Business Structure
Types of Money Services Provided
Other
Responsible Person/Owner Name
First NameLast Name
Responsible Person/Owner Email Address
example@example.com
Compliance Contact Name
First NameLast Name
Compliance Contact Email Address
example@example.com
Business Website (if applicable)
Years in Operation
Please provide any additional information relevant to your registration.
Signature of Authorized Representative
Powered by Jotform SignClear
Should be Empty: