NO FEE REQUIRED STATE OF MAINE APPLICATION FOR INCLUSION ON LIST OF SERVICE COMPANIES The following company or individual is willing to provide service for customers who deal with the Division of Corporations & UCC. Name of individual or company: _______________________________________________________________________________________________________ Contact person (if applicant is a company): _______________________________________________________________________________________________________ Address: _______________________________________________________________________________________________________ (physical location - street (not P.O. Box), city, state and zip code) _______________________________________________________________________________________________________ (mailing address if different from above) Telephone number: _____________________________ Fax number: _____________________________ E-mail address: ____________________________ Dated: ________________________ ___________________________________________________ (signature of applicant) ___________________________________________________ (type or print name and capacity) SUBMIT COMPLETED FORMS TO: UCC FILING SECTION, SECRETARY OF STATE, 101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101 TEL. (207) 624-7752 FORM NO. UCC-108 Rev. 4/16/2001 American LegalNet, Inc. www.FormsWorkFlow.com