Washington State Department of Financial Institutions

Tax Refund Anticipation Loan
 Facilitators' Registration Form

You may fill out this form on your computer screen. After you've typed the information, print the completed form using the "Print this page" button below.

Mail the completed form, a copy of the IRS letter issuing the EFIN, and your registration fee of $35.00 per EFIN to the Department of Financial Institutions, P.O. Box 41200, Olympia, WA 98504-1200.

Company Name
Trade Name
Contact Person
Physical Address
City
State Zip Code
Mailing Address
City
State Zip Code
Company Phone
FAX
Email
Website (URL)
E-File Provider Number (EFIN)

For additional offices, please use this form as many times as needed.