STATE OF NEW MEXICO
REGULATION AND LICENSING DEPARTMENT
FINANCIAL INSTITUTIONS DIVISION
2550 Cerrillos Road, 3rd Floor, Santa Fe, NM 87505
P.O. Box 25101, Santa Fe, NM 87505-5101
Phone: (505) 476-4819
Fax: (505) 476-4670
www.rld.state.nm.us/financialinstitutions
Licensing Specialist: Michelle.Medina@state.nm.us
APPLICATION FOR ORIGINAL LICENSE TO SELL NEGOTIABLE CHECKS, DRAFTS
AND/OR MONEY ORDERS
GENERAL INSTRUCTIONS
1. Use this form if you are applying for a license to sell negotiable checks, drafts and/or money orders.
2. The application must be completed in its entirety. Applications containing incomplete responses, or lacking
fees or exhibits will be returned to the applicant. Please complete the checklist on the last page of this
packet to ensure that your renewal application is complete.
3. If the space provided for answers is inadequate, additional pages should be attached, however, attachments
must identify the following information in the top right corner of every page: applicant name, and
the specific item on the application to which the answer relates.
4. All exhibits must include the following information in the top corner of every page: applicant name,
and exhibit number.
5. The license fee is one hundred and fifty dollars ($150.00). Agent fees are twenty five dollars ($25.00)
per agent. The only acceptable methods of payment are checks or money orders payable to the Financial
Institutions Division.
6. All licenses to sell negotiable checks, drafts and/or money orders will expire at the close of business
on February 28th of each year, unless renewed for the upcoming year.
7. The notarized application and fee must be mailed to: The Financial Institutions Division, P.O. Box 25101
Santa Fe, NM 87505.
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GENERAL APPLICANT INFORMATION
1
Principal Name of
Applicant:
2
Doing Business As
(DBA)
Type of Business
Organization:
(The person or legal entity applying for this license)
3
4
Applicant Website:
5
Information for
contact person to
whom all official
correspondence may
be sent:
☐ New Mexico Corporation ☐ Foreign Corporation ☐ Limited Liability Company (LLC)
☐ Partnership
☐ Sole Proprietor ☐ Limited Liability Partnership (LLP)
(Email)-This field must be completed to receive official correspondence
(Name of Contact Person)
(Mailing Address for Contact Person)
(Phone Number)
6
Information for
registered agent:
(must be a resident of
New Mexico for
service of all judicial
or other process or
legal notice)
(Email)- If available
(Name of Register Agent)
(Mailing Address for Register Agent)
(Phone Number)
7
8
9
Principal mailing
address for the
business location
that maintains this
(Mailing Address)
license:
(City)
Principal physical
address for the
business location
that maintains this
license:
Information for bank
where account will
be maintained. If
more than one
account will be
maintained, supply
(Fax Number)
(Fax Number)
(State)
(Zip Code)
(Street Address)
(City)
(State)
(Zip Code)
(Bank Name)
(Bank Address)
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additional
information as an
attachment.
(City)
10
11
12
Provide the
following:
Provide the
following:
Provide the
following:
13
Provide the
following:
14
Provide the
following:
(State)
(Zip Code)
(Account Name)
(Account Number)
Attach as Exhibit 1 Letter(s) of Recommendation from bank(s) with whom
the applicant does business.
Attach as Exhibit 2 Description of Business.
Attach as Exhibit 3 - A Financial Statement of Applicant as of the last fiscal
year-end for which an annual statement has been prepared and certified by a
certified public account, in accordance with generally accepted accounting
practices. Statements dated in excess of 12 months will not be accepted.
Attach as Exhibit 4 - Evidence of Compliance with the Bonding
Requirements of the Act, Section 58-20-1 (D) NMSA 1978. Bonding
requirements are ten thousand dollars ($10,000) for the licensee and an
additional five thousand dollars ($5,000) for each location within the state at
which negotiable instruments are issued or sold. Total bonding coverage is not
to exceed two hundred thousand dollars ($200,000) per licensee.
Attach as Exhibit 5 - A List of Agent's Names and their business addresses
that will issue money orders in this state.
I. REGULATORY DISCLOSURE
Within the past year, has the applicant, or any parent company, or any partner, member, officer, director
or trustee:
15. Applied for any other type of business license with this Division?
Yes
☐
No
☐
16. Been refused any type of business license by a state or federal
financial institutions regulating agency?
Yes
☐
No
☐
17. Been the subject of enforcement actions such as cease and
desist orders, consent orders, injunctions, and license suspensions
or revocations by any state or federal regulatory agency?
Yes
☐
No
☐
REGULATORY DISCLOSURE EXHIBITS
☐ EXHIBIT A: BUSINESS LICENSING INFORMATION
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
If you answered YES to question 15, please attach complete details of all applications
submitted to this Division, including the following information:




☐ EXHIBIT B:

The name of the business listed on the application;
The type of business license applied for;
A statement indicating whether the license was granted or denied;
If the license was granted, the license number;
REGULATORY ENFORCEMENT ACTION HISTORY
If you answered YES to question 16 or 17, please attach complete details of all events or
proceedings, including the following information:
 The name of the regulating agency that executed the enforcement action;
 The contact information for the regulating agency that executed the
enforcement action;
 A copy of the enforcement action filed by the regulating agency;
 Any other relevant information.
ATTACHMENT EXHIBITS
☐ EXHIBIT 1:

LETTERS OF RECOMMENDATION
Submit a letter of recommendation for all banks listed in question 10.
☐ EXHIBIT 2: DESCRIPTION OF BUSINESS

☐ EXHIBIT 3:

Submit a description of your business activity.
FINANCIAL STATEMENT
Submit a financial statement for the last fiscal year-end that meets the following
criteria:
☐ Prepared and certified by a certified public accountant;
☐ Prepared in accordance with generally accepted accounting practices;
☐ Statement must be dated within the past 12 months, or will not be accepted;
☐ EXHIBIT 4:

EVIDENCE OF BOND
Submit evidence of a bond that complies with the following requirements set forth
under 58-20-1(D) NMSA 1978:
☐ Ten thousand dollars ($10,000.00) for the licensee;
☐ Additional five thousand dollars ($5,000.00) for
each location within the
State at which negotiable instruments are issued or sold;
☐
Total bonding coverage is not to exceed two hundred thousand dollars
($200,000.00) per licensee;
☐ EXHIBIT 5:

LIST OF AGENT'S NAMES
Submit a list of agent's name and business addresses that will issue money orders in
this state.
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APPLICANT’S OATH AND STATEMENT
STATE OF_______________________ )
)
COUNTY OF_____________________ )
I, _________________________________, the undersigned, being the ___________________________
(printed name of authorized representative)
(Officer [title], partner or owner)
of ________________________________________________________ understand that application is
(name of applicant company)
hereby made for a license to sell negotiable checks, drafts and/or money orders as provided for in Chapter
58-20-1 et seq., New Mexico Statutes Annotated 1978, to engage in business at the location herein
specified. I hereby affirm that all information, statements, attachments, and exhibits submitted with this
application are true and correct and to the best of my knowledge. I acknowledge that any misstatements
contained herein may cause the Financial Institutions Division to deny the application for license, or to
initiate later proceedings against this license. I understand that a license, if granted, is a revocable
privilege to be enjoyed and exercised only in accordance with all the terms and conditions of 58-20-1
NMSA 978 et. seq. and the accompanying lawful regulations promulgated by the Director.
________________________________
(Signature of Authorized Representative)
EXECUTED THIS ________________day of _________________, 20______.
SUBSCRIBED AND SWORN TO before me on this _____ day of ______________, ______ by
_______________________________________ in ___________________________, _______________.
(name of person making statement)
(City)
(State)
________________________________
(Notary Public)
My commission expires:
(Notary seal)
________________________________
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APPLICATION CHECKLIST
Before submitting your application to the Financial Institutions Division, please ensure that the following
items are included in your submission packet:
☐ All attachments include applicant name, and question number in the top right corner of each
page.
☐ All exhibits include the applicant name, and the exhibit letter in the top right corner of each
page.
MANDATORY EXHIBITS AND FORMS:
☐ EXHIBIT 1: LETTERS OF RECOMMENDATION
☐ EXHIBIT 2: DESCRIPTION OF BUSINESS
☐ EXHIBIT 3: FINANCIAL STATEMENTS
☐ EXHIBIT 4: EVIDENCE OF BOND
☐ EXHIBIT 5: LIST OF AGENT'S IF APPLICABLE
☐ APPLICANT’S NOTARIZED OATH AND STATEMENT
☐ CHECK OR MONEY ORDER PAYABLE TO FINANCIAL
INSTITUTIONS DIVISON FOR LICENSE AND AGENTS FEE
MANDATORY EXHIBTS IF APPLICABLE:
☐ EXHIBIT A: BUSINESS LICENSING INFORMATION
☐ EXHIBIT B: REGULATORY ENFORCEMENT ACTION HISTORY
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