Maryland SDAT CORPORATE CHARTER DIVISION Expedited Request by Fax Cover Sheet NOTE: All faxed filings and requests are expedited and an expedited filing surcharge beyond the processing fee applies to each request. See Fee Schedule at http://www.dat.state.md.us/sdatweb/fees.html for the appropriate fees or e-mail the division at charterhelp@dat.state.md.us or telephone for new filings only 410-767-1340, for all other calls 410-767-1350. ____________________________________________________________________________________________________ Fax all request to: (410) 333-7097 Please type or print legibly, you may also fill this form out on your pc. Name of entity:______________________________________________________________________ Fax number: ____________________________________________ Phone number: _______________________________________ Number of pages transmitted:_________ Contact person: _______________________________________________ Name and address for return mail: ____________________________________________________________ ___________________________________________________________________________________________________________ SERVICE REQUESTED Check all that apply NEW ENTITY FILING File document Return original document Note a $5.00 fee applies to this service Certified copies of document being filed _____Number of certified copies Short form Certificate of Status ______Number of certificates RECORD REQUEST Department ID number____________________________ Entity name________________________________________________________________________ Certificate of Status for existing entity _____Number of certificates Copies of documents previously recorded Attach separate sheet and specify: the name and title of each document; the date of recording, if known; liber and folio, if known; the number of copies wanted of each document. __________________________________________________________________________________ CREDIT CARD INFORMATION MASTERCARD VISA (At this time we only accept Mastercard and Visa) Cardholder’s name______________________________________________________ Credit card number _______________________________________________________________ Expiration date______________________________________ Signature of Cardholder_____________________________________________________________ This transaction will not be accepted without a signature. =======================================FOR DEPARTMENTAL USE ONLY====================================== AUTH NO.___________________________________CLERK: ___________ FEE:_______________ American LegalNet, Inc. www.FormsWorkflow.com