Form E-820: Service Company Application Checklist

This is the primary application form for a service company permit.  The form and its instructions identify other documents you must submit with this form.  You must complete the form on a computer - do not print it out until it is complete and all requirements are satisfied.

A motor vehicle service contract administrator or insurer must use this form and submit a fee to file an application for approval of a motor vehicle service contract program.  ARS § 20-1095.06.

Complete this form to report:

• All members of the board of directors/trustees, members of the executive committee or any other governing board of the committee; and,
• If applicant is a corporation, all officers and all shareholders that directly or indirectly own 25% or more of the voting securities of the applicant if a corporation; and,
• If applicant is a partnership or association, all partners.

IMPORTANT! The Department will investigate information provided and may deny or refuse to renew a permit if the applicant fails to provide complete and truthful information about itself and the individuals responsible for the service company’s affairs.