Washington State Department of Financial Institutions

Securities Division Forms

Below is a list of  forms available from the Securities Division. If a form that you want is not available online, please e-mail Carol Kelsey at Carol.Kelsey@dfi.wa.gov or call her at 360-902-8760 and she will send you the form(s).

Unless otherwise noted, all forms on this page are in PDF* format. Many forms can be filled out online and printed, although you cannot save them with your text in them unless you have the full Adobe Acrobat software application, not just the free Adobe Reader. PDF forms that can be completed online and printed are noted by the words (PDF Online).

Broker-Dealer Licensing

Consent to Service of Process (U-2 & U-2a) (PDF)
Form BD (PDF)
Form BDW (PDF Online)
Salesperson Form (U-4) (PDF Online)
Agent Termination Form (U-5) (PDF)
Exams Form (U-10)

Business Opportunities

Consent to Service of Process (U-2 & U-2a) (PDF Online)
Business Opportunity Registration Application (PDF)

Franchises

Consent to Service of Process (U-2 & U-2a) (PDF)
Franchise Registration Application (PDF)
Franchise Exemption Application (PDF)
Salesman Disclosure Form (PDF)
Franchise Broker Application (PDF)
Franchise Impound Agreement (PDF)
Franchise Guarantee of Performance (PDF)
Sample Washington Franchise Agreement Addendum (PDF)
Franchisor Surety Bond (PDF)

Investment Adviser Licensing

Form ADV
Form ADV-Part 2 (PDF)
Agent Termination Form (U-5) (PDF)
Exams Form (U-10)
Surety Bond Form (PDF)

Securities Registrations, Notifications, and Exemptions

Consent to Service of Process (U-2 & U-2a) (PDF)
Coordination Application (U-1) (PDF)
Qualification Application (PDF)
Mortgage Paper Securities Application (PDF)
Mortgage Paper Securities Sample Specific Offering Circular (Word)
Mortgage Paper Securities Sample Specific Offering Circular (PDF)
Mortgage Broker-Dealer Quarterly Report (PDF)
Mortgage Broker-Dealer Surety Bond (PDF)
Mortgage Broker-Dealer Sample New Account Form (PDF)
Mortgage Broker-Dealer Sample New Account Form (Word)
Municipal Security Notice Filing (PDF)
Promotional Shares Escrow Agreement - Model A (PDF)
Promotional Shares Escrow Agreement - Model B (PDF)
Promotional Shares Lock-in Agreement - Model A (PDF)
Promotional Shares Lock-in Agreement - Model B (PDF)
Impound of Offering Proceeds Agreement (PDF)
Quarterly Report Form (PDF)
Quarterly Report Form - Debenture Co. (PDF)
Form D - Reg D Rules 504, 505, or 506 (PDF)
Notice of Exemption - Rules 504 & 147 (PDF)
Notice of Exemption - Non-Profit (PDF)
Notice of Exemption - Co-op/Mutual Assns. (PDF)
CR-SCOR-West Application (PDF)
Sample Rescission Letter (PDF)
Model Accredited Investor Exemption Form (PDF)
Form NF (PDF)
Coordinated Review - Equity Form
Qualification for Government or QUASI-Governmental Bond Issues (PDF)

SCOR Information

The following forms and information are available on the NASAA website.  Click on the appropriate link below to go directly to the page requested.

SCOR Manual (Word)
SCOR Form, Introduction, Instructions, Requirements
Small Company Offering Registration Form (U-7) (Word)
Statement of Policy Regarding Small Company Offering Registrations

Escrow Agents

Note: Beginning July 1, 2006, the Division of Consumer Services administers Escrow Agents instead of the Division of Securities. Escrow related pages, forms, and links have been updated to reflect this change. Please contact the Division of Consumer Services at dcs@dfi.wa.gov or call 360-902-8703 with any questions.

Information Requests

Public Records Request Form (PDF)

Complaints

Investor's Complaint Form (PDF)

To learn when and how you should file a complaint, and what the Securities Division can do for you, read the information found on the Investment Complaints page.

* To open a PDF file, and you will need Adobe Acrobat Reader to view it. If you don't already have Acrobat Reader installed on your computer, you may download it for free from Adobe.

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