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Iowa Incorporation

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					           Iowa Residential Service Company License Report (Chapter 523C)
For The Fiscal Year Ended:                __________________________________,20_______
Application For (Check on with an "X"):
Initial License ($250.00 Fee)

License Renewal ($250.00 Fee)

Current RSC License No. (if applicable)   RSC____________-___________

 Name of Residential Service
 Company:


 Business Address:

 City:

  State:

  Zip Code:



  Telephone Number:

  Fax Number:

 Mailing Address ( if different)

 Address :

 City :

 State:

 Zip Code:

 Telephone Number:
 Business Email:
 Fax Number:

 Contact Person:

 Address:

 City:
 State:

 Zip Code:


 Telephone Number:

 Fax Number:

 Contact Email Address:

 State of Incorporation:

 Federal Identification Number:


Name of the applicant’s registered agent
for service of process within Iowa:

 Address :

 City:

 Zip Code:



List the names, titles, and addresses of all
executive officers and directors:

 Name:

 Title:

 Address:

 City:

 State:

 Zip Code:



 Name:

 Title:
Address:

City:

State:

Zip Code:



Name:

Title:

Address:

City:

State:

Zip Code:



Name:

Title:

Address:

City:

State:

Zip Code:



Name:

Title:

Address:

City:

Zip Code:
Describe the services to be performed by
the service company and the terms and
conditions of performance.



In submitting this application, you must also upload and submit the following documents (if applicable):
a. An affidavit attesting to a satisfactory net worth &disclosing the number of contracts issued. Exhibit A
b. An affidavit attesting to the reserve account balance. Exhibit B
c. A surety bond in the amount of $100,000.
d. A copy of the applicant’s most recent financial statements.
e. Certificate of Good Standing.
f. Articles of Incorporation.
g. Bylaws.


In the event this application is approved, I understand and agree that:
a. The applicant will notify the Superintendent of Securities, within 30 days of such an event, if the
licensed service company fails to pay any final judgment rendered against it in this state within 60 days
after the judgment became final.
b. The applicant will notify the Superintendent of Securities, within 30 days of such an event, if the
licensed service company refuses to perform services required to be performed under its residential
service contracts in this state.
c. The applicant will notify the Superintendent of Securities, within 30 days of such event, if the licensed
service company fails to maintain the net worth required by Section 523C.6.
d. The applicant will notify the Superintendent of Securities, within 30 days of such event, if the licensed
service company fails to maintain the reserve account required by Section 523C.11.
e. The applicant will notify the Superintendent of Securities, within 30 days of such event, if the licensed
service company fails to maintain its corporate certificate of good standing with the Secretary of State.

				
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