ࡱ>  @ bjbj{{  L}rrr9998&::4Y*=z?(???BCDLYYYYYYY$ZR&]V7YirHB^BHH7Y??Y'M'M'MHR?r?Y'MHY'M'MOP"rO?= `@29gIOP|Y0YO,|]J|]O|]rODE'MXFFDDD7Y7Y%(d M( STATE OF SOUTH CAROLINA DEPARTMENT OF CONSUMER AFFAIRS CREDIT COUNSELING APPLICATION UPDATE/CHANGE FORM S.C. Code Ann. 37-7-101 through - 122. www.scconsumer.gov 803-734-4236 DO NOT FAX THIS FORM (An original, signed and notarized form is required) This form may be duplicated. Print legibly or type information requested on the form in its entirety. If any of the information on this form changes, submit a revised form to the department. Attach additional page(s) as necessary. 1.Company Name: FORMTEXT      2. Company License No.: FORMTEXT      3.Contact Person: FORMTEXT       FORMTEXT       FORMTEXT      (Last)(First)(Middle)4.Business Headquarters Address: FORMTEXT      (Street) FORMTEXT       FORMTEXT    FORMTEXT       FORMTEXT      (City)(State)(Zip Code)(County)5.REASON FOR SUBMISSION (Check the appropriate box and give complete information for each section checked)a.EMPLOYEE CHANGE: (includes counselor, owner, member, officer or director)Employee Name  FORMTEXT       FORMTEXT       FORMTEXT      (Last)(First)(Middle) FORMCHECKBOX Name Change (Give Your New Legal Name) FORMCHECKBOX Home Address Change (Give New Home Address) FORMCHECKBOX Employee Status Change (Give New Title) FORMCHECKBOX Inactivate Employee (Give Termination Date) FORMCHECKBOX Business Address Change (Give New Address Where Employed)Change: FORMTEXT      b.LOCATION CHANGE: (Attach a listing of employees indicating transfer or termination. Include the employee name and license number.) 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I further certify that I understand that giving false information constitutes cause for denial or revocation of the application and subjects me to criminal prosecution for perjury. I acknowledge that I have a duty and agree to update and correct this information as it changes.  FORMTEXT      Signature of Person Completing the FormType or Print your name and Business Relationship or TitleSWORN TO AND SUBSCRIBED before meThe South Carolina Freedom of Information Act may require the Department of Consumer Affairs to release this form as a public record; however personal identifying information will be released only if required by law. thisday of20Notary Public ForMy Commission Expires: Applicant Update Change Form Rev. 08/07 Page  PAGE 1 of  NUMPAGES 2 Street Address 3600 Forest Drive, 3rd Floor Columbia, SC 29204-4406 Mailing Address P.O. 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