Copyright Capital Retail Solutions, Inc. All rights reserved.
GETTING STARTED...

In order to customize your Anti-Money Laundering Compliance Program, submit the following questionnaire
form. All information is strictly confidential. One of our experienced professionals will contact you by telephone
within 24 hours to discuss further information and pricing.
*Owner's Name:
*Business Name
(Legal name shown on
Business License):
*Address of Store:
*City, State, Zip:
*Email address:
*Store Phone:
*Store Fax:
*Alternate number:
*Manager's Name:
*How many employees
perform money
services?:
Who would you like to designate as your Compliance Officer?
(usually an owner or manager)
*Name:
*Address:
*City, State, Zip:
*Phone:
*Social Security #:
*Available Hours:
*Are you being audited by an
IRS Compliance Officer?
YES
NO
*Are you being audited by a
field auditor from your bank or
wire transfer service?
YES
 NO
*Do you have Paycheck
Secure, our biometric check
cashing system, installed?
NO
YES
*What money service(s) do
you perform? (check
appropriate boxes)
Check Cashing
Money Order Sales
Money Order Redemptions
Wire Transfers
Traveler's Check Sales
Traveler's Check
Redemption
Payday Loans
Gold & Silver
Jewelry
Other:
*What is the status of your
Business License?
Pending
Current
None (Need an application)
*What is the status of
your MSB Registration?
Pending
Current
None (Need an application)
*What is the status of your
Check Cashing Permit?
Pending
Current
None (Need an application)
What is the status of
your Deferred Deposit?
Pending
Current
None (Need an application)
Additional Comments:
* Information Required for Sending Request