FAX FILING SERVICE REQUEST SECRETARY OF THE STATE FAX BUSINESS FILINGS TO: (860) 509-6069 UCC/COPIES/LEGAL EXISTENCES TO: (860) 509-6057 OFFICE USE ONLY AMT. REC’D $ CA CR TRANS. ID We do not confirm receipt of fax via telephone. Please set your fax machine to confirm successful transmissions. BATCH DATE EXP/REG RETURN TO: Number of Pages including transmittal sheet: _________ REQUESTING PARTY’S INFORMATION: Name: _____________________________________________Company/Firm: ________________________________________ Address:_________________________________________________________________________________________________ Contact Person Telephone # (Required): ( Type of Service Request: ) ______________________________________________________________ Business Filing UCC Filing (cannot be expedited) Copy or Certificate Request Business Name / UCC Name ___________________________________________________________________________ SELECT EXPEDITED or ROUTINE SERVICE EXPEDITED SERVICE ($50.00 each item) _____Pick-Up _____Mail ROUTINE SERVICE -Additional $50.00 fee must be included for each expedited item requested. Add this amount to each service/filing fee. -Completed within 24 hours of receipt -Mailed next business day at 4:00PM if not picked up -Completed within 3 to 5 business days -Mailed when completed -Pick-up is not available REQUEST FOR COP(IES) OR CERTIFICATE(S) OF LEGAL EXISTENCE Plain Copy ($40.00) ***EXPEDITED-ADD $50 PER ITEM*** Certified Copy ($55.00) ***EXPEDITED-ADD $50 PER ITEM*** Please specify the name of the document copy being requested: __________________________________________________ __________________________________________________ Certificate of Legal Existence (Fees for Limited Liability Companies / LP’s) Certificate of Legal Existence (Fees for Corporations / LLP’s / Statutory Trusts) ____Express $50.00 _____Short $50.00 (reflects all name changes) _____Long $100.00 (cannot be expedited) ***EXPEDITED-ADD $50 PER ITEM*** _____Express $50.00 _____Short $80.00 (reflects all name changes) _____Long $120.00 (cannot be expedited) ***EXPEDITED-ADD $50 PER ITEM*** METHOD OF PAYMENT: By indicating a Customer ID or credit card #, you are hereby authorizing debit of the account/charge of credit card. Total Charge: ___________ Note: Expedited service requires an additional fee. If the fee(s) are not included, the request(s) will be completed on a routine basis. Payment by an established Customer Account: Customer ID#: ___________________________________________________ Payment by: VISA or MASTERCARD (only Visa or MasterCard accepted) Name on Credit Card: __________________________________________________________________________________ 16 Digit Credit Card #: _____________ _____________ _____________ _____________ Expiration Date: ___________/__________ Month Year Security Code:__________ (the last 3 digits on back of card) Zip Code: (must match this credit card billing address)___________________ Revised 10/22/09 American LegalNet, Inc. www.FormsWorkFlow.com