STATE OF OHIO Office of the Secretary of State Secretary of State Prepayment Account Application Form Please indicate whether this account is for prepayment of Corporate or Uniform Commercial Code Filings. Business Name Corporate Attention: Please note: If you will be submitting both types of filings, a separate Prepayment Account must be established for each type. UCC Note: Funds cannot be transferred between accounts. Business Address The Prepayment Account # is Confidential , and as such, should be guarded from access to # and use. Unauthorized use may result in cancellation of filings processed. LOW ACCOUNT BALANCE NOTICE: Please indicate the balance amount you wish to select for notification that an additional deposit may be needed. Telephone Number Area Code Amount of Initial payment $ $ Minimum Amount: $500 Attach check, money order or cash receipt for initial payment to this form. Please list the names and phone numbers for two people in your office who will be the Primary and Secondary contact for SOS personnel concerning this account. Primary Contact Secondary Contact Phone Number Phone Number Area Code Area Code Email Address Email Address FAX # FAX # Area Code Area Code I hereby request and authorize the Secretary of State of Ohio to deduct from this prepayment account the filing fees for the classification of filings included above. The Secretary of State will hold this prepayment in an escrow account and deduct funds as appropriate for approved filings. I understand that I am responsible to monitor the activity on the account usage, and notify the Secretary of State of discrepancies within 45 days of date of posting. Account information may be monitored via the internet at: www.state.oh.us/sos/ once the User Name and Password has been established. A signed contract must accompany application and minimum $500 deposit to process request to establish a Prepayment Account. (Please print Name) (Please print Title) (Signature) (Date) Last Updated: 1/4/2002 Secretary of State Office Use Only Prepayment Account #: ' ' ' ' ' ' ' ' ' Application Approved By: ' Established in Accounting Database: Business Services: Date: Business Services: Established on Web: Finance: Date: Date: Established on WIP: American LegalNet, Inc. www.FormsWorkflow.com American LegalNet, Inc. www.FormsWorkflow.com