SECRETARY OF STATE STATE OF MONTANA Brad Johnson Secretary of State Montana State Capitol PO Box 202801 Helena, MT 59620-2801 Return To: Brad Johnson Secretary of State Montana State Capitol PO Box 202801 Helena, MT 59620-2801 ATTENTION: MANAGEMENT SERVICES I(we) would like to take advantage of the prepaid account system to expedite the handling of service requests with the office of the Secretary of State. I(we) understand that my(our) account will be charged for each transaction and the account is expected to be maintained with a positive balance. (Please print or type the following information) Name of Firm:________________________________________________ Mailing Address:_____________________________________________ City, State, Zip:____________________________________________ Contact Person:______________________________________________ Phone Number:________________________________________________ Fax Number:__________________________________________________ Amount to Open Account:______________________________________ TIN: _________________________(must be 9 digits) REQUIRED Reception: (406) 444-2034 - Business Services Bureau: 444-3665 - Elections Bureau: 444-4732 Administrative Rules Bureau: 444-2055 - Records Management Bureau (1320 Bozeman Avenue): 444-2716 Fax: 444-3976 http://sos.mt.gov American LegalNet, Inc. www.FormsWorkflow.com