Office Use ______________ r Please mail egistration and make check payable to: Secretary of State / Trade Name Division 1700 W Washington 7th Fl. Phoenix, Arizona 85007 Walk-in service , Tucson: 400 W. Congress, Ste. 252 (602) 542-6187 800) 458-5842 (within Arizona) Filing Fee: $10.00 ttenneB neK 1 1 1: P: 30 mooR ,. lF ts notgnihsaW . W 007 xineoh . ( eerF lloT APPLICATION FOR REGISTRATION OF TRADE NAME (A.R.S. § 44-1460) The Registration of Trade Names and Trademarks is not legally required in Arizona, but is an accepted business practice. This is a registration for an Arizona Trade Name only in accordance with A.R.S. §441460. The registration of a trade name is a public record and does not constitute exclusive rights to the holder of the name. Names with a corporate ending (e.g., Inc., LLC or Ltd.) are not acceptable. Please clearly print or type your application to avoid registration errors. Name, title or designation to be registered: Name of Applicant(s): (If more than 1 applicant, an “or” designation is assumed unless otherwise indicated) Your certificate and renewal notices are dependent on accurate address information including suite numbers. Remember to update your registration if you move. Business Address: Street or Box Number City State Zip Phone (Optional): Applicant must check one. Do not select “Corporation” or incorporated, or your application will be returned to you. Individual Partnership Corporation “LLC” if you are not currently Foreign corporation licensed to do business in Arizona Association Organization LLC Other The date in which the name, title or designation was first used by the applicant within this state. This date must be today’s date or prior to today’s date: Month Day Year General nature of business conducted: Applicant’s Printed Name Applicant’s Signature Applicant’s Printed Name Applicant’s Signature State of Arizona County of On this day of , 20 , (Name of Applicant) personally appeared before me and acknowledged that he/she signed this document for it’s stated purpose. Notary Public American LegalNet, Inc. www.FormsWorkFlow.com TN apptn Revision 093009