Follow the steps to complete your registration form effectively.

1. Click the ‘Get Form’ button to access the form and open it in the designated editor.
2. Begin with the Registrant Identification Information section. Here, you will need to accurately enter your business name as registered and your Federal Employer Identification Number (FEIN).
3. In the next field, provide the name that will appear on service contracts if it differs from the business name provided.
4. Enter a current telephone number where you can be reached.
5. Specify a contact person who will be responsible for any correspondence regarding the application.
6. Include a contact email address for digital communication.
7. Fill out the mailing address where official correspondence should be sent.
8. Record the physical location of your business.
9. Indicate the type of organization you are operating under (for instance, Sole Proprietorship, Partnership, Corporation, LLC, etc.).
10. Provide the state of incorporation for your business.
11. If applicable, list the Service of Process Information. If you are not registered to do business in Vermont, include the name and address of a representative in Vermont for service of process.
12. Complete the section regarding your service contract reimbursement reinsurer by providing the name, address, and policy number if available.
13. If you utilize a third-party administrator, include their name, address, and phone number.
14. Make sure to attach a check for the 3-year registration fee of $600, made payable to the Department of Financial Regulation.
15. Once all sections are completed, review the information for accuracy before signing the certification section, where you will affirm the truthfulness of your statements, the compliance with Vermont statutes, and your authority to submit the application.
16. Finally, save the changes made to the document, and you may choose to download, print, or share the completed form as needed.

Complete your VT Service Contract Provider Registration and Certification document online today!