1. Name of Licensee:

2. Licensee's Business Address:

3. CFL License Number: _______________

4. Name of Finder:

5. List all Fictitious Business Names used by the Finder:

6. Finder's Main Business Address:

7. Is the Finder registered with the California Secretary of State? Yes ​ No ​

8. Finder's type of business entity (Corporation, Limited Liability Company, Limited Partnership, General Partnership, or Limited Liability Partnership):

9. List all types of business activities conducted by the finder outside the authority of the California Financing Law:

10. In the table below, list all government entities that regulate the finder's business activities, including all corresponding license, permit, and registration numbers, status, and expiration dates:

11. In the table below, provide information for each instance where the finder has been subject to disciplinary action by a government entity:

12. Have you entered into a written agreement with the finder as required under Section 22376 of the Financial Code? Yes ​ No ​

13. Does the written agreement include a provision that the finder agrees to comply with all regulations established by the Commissioner concerning the activities of finders as required under Section 22376 of the Financial Code? Yes ​ No ​

14. Does the written agreement include a provision that the finder agrees to provide the Commissioner access to all of the finder's books and records pertaining to the finder's operations under the agreement with the licensee? Yes ​ No ​

15. Provide the following information for an employee of the finder who is knowledgeable about, and has the authority to execute, the contract governing the business relationship between the finder and the licensee:

Name:

Address:

16. Complete Exhibit A identifying the business addresses of all locations at which the finder will perform the services described in Section 22372, subdivisions (a) and (b), of the Financial Code. Any subsequent locations or changes to locations or other information contained in the finder registration form must be reported to the Commissioner in accordance with Title 10 of the California Code of Regulations, Section 1600.

17. Complete Exhibit B providing the name, title, physical business location, telephone number, and email of each employee of the finder who is responsible for that finder's finding activities on behalf of the licensee at each of its locations. If different employees are responsible for different locations, provide the name and contact information of the employee responsible for each location. If one employee is responsible for the finder's activities, provide the name and contact information of the employee for all locations.

18. Complete Exhibit C identifying the services and activities that the finder will perform for the licensee at the finder's physical location for business. Will any of the finders listed in Exhibit C perform additional services authorized under Section 22372, subdivision (b) of the Financial Code?

Yes ​ (If yes, please provide the licensing details for finders performing additional services, as specified and where indicated in Exhibit C.)

No ​

19. Attach a copy of the written agreement with the finder, marked as Exhibit D. The licensee has duly caused this registration to be signed on its behalf by the undersigned, thereunto duly authorized.

The undersigned, on behalf of the licensee, acknowledges that this registration and all exhibits thereto are subject to public inspection pursuant to Section 250.9.1, Chapter 3, Title 10, California Code of Regulations. A request for confidentiality of certain documents may be requested pursuant to Section 250.10. If a request for confidential treatment is granted (or denied), the person making such request will be notified in writing.

I declare under penalty of perjury that I have read the foregoing registration, including all exhibits attached thereto, or filed therewith, and know the contents thereof, and that the statements therein are true and correct.