Notification of Changes for Business Entity
General Information
Business Entity Name:	EPS SETTLEMENTS GROUP, INC.
Incorporation / Formation Date:	06/24/1986
FEIN:	954134668
Ohio License Number:	23987
NPN:
DBA / Trade Name:
State of Domicile:	CA
County:	LOS ANGELES
Business Address
Address 1:	5901 W. CENTURY BLVD., STE. 504
Address 2:
City:	LOS ANGELES
State:	CA
Zip:	90045
Phone:	303-337-0400
Fax:
Business Web Site Address:
Business Email Address:	NERBECK@STRUCTURES.COM
Mailing Address
Address 1:	5613 DTC PARKWAY, STE. 700
Address 2:
City:	GREENWOOD VILLAGE
State:	CO
Zip:	80111-3035
Indicate the type of change you are seeking
Address Change:	YES
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	NO	New DBA/Trade Name:
Amend DBA/Trade Name:	NO	Old DBA/Trade Name:
Add/Delete Producers, Members, Owners, Partners, Officers and/or Directors:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date

Title Business Entities Only
1. Is any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance? (i.e. banking, auto dealer, mortgage company)	NO
2. Has any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance since the filing of the previous CN-65 or the original application?	NO
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement

Submitted By
Submitted By:	NANCY L. ERBECK
Title:	NATIONAL LICENSING MANAGER
Phone Number:	513-298-1962
Email Address:	NERBECK@STRUCTURES.COM