Check Payment Form
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Check Payment Form. This is a Official Federal Forms form and can be use in General Forms NASDAQ.
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Check Payment Form If paying by check, please complete this form and include it along with your payment. If paying by wire, please click here for instructions. All checks should be made payable to The Nasdaq Stock Market LLC at the following address: For payments sent by regular mail: The Nasdaq Stock Market, LLC. P.O. Box 780700 Philadelphia, PA 19178-0700 For payments sent by overnight mail: The Nasdaq Stock Market, LLC. Lockbox - 780700 Wells Fargo Bank MAC Y1372-045 401 Market Street Philadelphia, PA 19106 COMPANY NAME SYMBOL ADDRESS ADDRESS REMITTER NAME (if different than Company Name) AMOUNT CHECK NO PLEASE INDICATE REASON FOR PAYMENT BY CHECKING ONE OF THE FOLLOWING BOXES: New Company Application and Entry: The application fee is $25,000 for the Global or Global Select Market, $5,000 for the Capital Market, $1,000 for companies applying to list Closed End Funds, Exchange Traded Funds, Index Fund Shares or other structured products and $5,000 for companies applying to list non-convertible bonds. The remainder of the entry fee is due prior to the first day of trading. Nasdaq will credit all application fees paid by the Company in connection with an application that has not been closed towards the Entry Fee payable upon listing. Application Renewal Fee: If a Company does not list within 12 months of submitting its application, it will be assessed an additional non-refundable $5,000 application fee each 12 months thereafter to keep its application open. Hearing or Appeal Request: The fee in connection with a hearing or an appeal of a Hearing Panel decision to the Nasdaq Listing and Hearing Review Council is $10,000. Transfer Application: The fee for companies transferring from the Global or Global Select Market to the Capital Market is $5,000. Last Revised 6/14/2019 American LegalNet, Inc. www.FormsWorkFlow.com