Nonprofit Corp. Fax Filing Cover Sheet Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Nonprofit Corp. Fax Filing Cover Sheet Form. This is a Massachusetts form and can be use in Corporations Division Secretary Of State.
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Tags: Nonprofit Corp. Fax Filing Cover Sheet, Massachusetts Secretary Of State, Corporations Division
The Commonwealth of Massachusetts
William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, 17th Floor, Boston, Massachusetts 02108-1512
Nonprofit Corp. Fax Filing Coversheet
Please Print Neatly
FAX INFORMATION
617-624-3891
Fax to: _________________________________________ Number of Pages (not including coversheet):_ ______________
Name of Entity being Filed:___________________________________________________________________________
Sender’s Name:___________________________________ Sender’s Telephone Number:____________________________
Senders Email address:_ ___________________________________________________________________________
E-check PAYMENT INFORMATION
E-check Routing Number:__________________________ Check Account Number:_______________________________
CREDIT CARD PAYMENT INFORMATION
Credit Card Type (please circle one):
s r
r
TM
Credit Card Number or Account Number:__________________________________ Security Indicator on VISA*:______
Name on Credit Card:_______________________________________________________________________________
Billing Address for Credit Card or E-Check Used
Street:____________________________________________________________________________________________
City or Town:____________________________________ State:______________________Zip:_____________________
Telephone Number:_________________________________________________________________________________
Expiration Month:________________________________ Expiration Year:_ ____________________________________
*The Security Indicator is required for payment by Visa credit card. The security indicator is the non-embossed 3-digit number
on the card signature panel found on the back of the card. In the signature panel, there is a large number (the account number)
followed by a separate 3-digit number. You need the separate 3-digit number.
There is an expedited service fee associated with fax filings. These fees cover the cost of the technical expertise necessary to provide
the convenience of on-line and fax filing. You can obtain the expedited service fee associated with your filing by visiting our
website at www.sec.state.ma.us/cor/corfees.htm and scrolling to the chart at the bottom of the page.
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