Entry Fee Payment Form - Payment Of Balance
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Entry Fee Payment Form - Payment Of Balance Form. This is a Official Federal Forms form and can be use in National Market Listing Applications NASDAQ.
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The NASDAQ Stock Market®
Entry Fee Payment Form:
Payment of Balance
Please note that entry fees due in connection with an application must be paid in full prior to the
admission of a security to trading on NASDAQ®. All fees are payable to The NASDAQ Stock Market LLC.
Payment By Wire: The company may remit its fees by wire. Please use the following instructions and
include the specific reference information provided below when transmitting your payment. Submission
of this form is not required.
By Federal Reserve Wire
The NASDAQ Stock Market LLC
Bank Name:
Wachovia Bank, N.A.
Bank Address:
12 East 49th Street
Bank Address:
New York, NY 10017
SWIFT Number:
PNBPUS3NNYC
ABA Number:
031201467
Beneficiary:
NASDAQ
Account Number:
2000031405177
Reference:
GL2100625, company
name, symbol and note that the fees are for
initial listing.
By American Clearing House
The NASDAQ Stock Market LLC
Bank Name:
Wachovia Bank, N.A.
Bank Address:
12 East 49th Street
Bank Address:
New York, NY 10017
SWIFT Number:
PNBPUS3NNYC
ABA Number:
026012881
Beneficiary:
NASDAQ
Account Number:
2000031405177
Reference:
GL2100625, company
name, symbol and note that the fees are for
initial listing.
Payment By Check: All checks must be sent under separate cover to the address provided below.
Please complete this form and submit it with your payment.
COMPANY NAME
ADDRESS
ADDRESS
REMITTER NAME
(IF NOT THE SAME AS THE COMPANY)
CHECK ENCLOSED IN THE AMOUNT OF $
CHECK NO.
Please mail this form and your payment by courier/overnight to:
The NASDAQ Stock Market LLC
Listing Qualifications
Lockbox 20200
c/o Wachovia Bank, N.A.
401 Market Street
Philadelphia, PA 19106
©September 2011, The NASDAQ OMX Group, Inc. All rights reserved. The NASDAQ Stock Market and NASDAQ are
registered trademarks of The NASDAQ OMX Group, Inc.
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