PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS Signature Form For PA Open For Business Electronic Filing Document must be dated, signed and mailed to the address listed below if a manual payment was selected. If an electronic payment was selected, you may fax this form to 717-705-0927. Please refer to the instructions below for filling out this form. Department of State Bureau of Corporations and Charitable Organizations P.O. Box 8722 Harrisburg, PA 17105-8722 Inquiries: (717) 787-1057 1. The enterprise structure is: 2. The enterprise legal name is: 3. The enterprise's fictitious name is (if applicable): IN TESTIMONY WHEREOF, the undersigned have caused this application to be executed this ______ day of ____________, _______. _____________________________ Signature ______________________________ Signature _____________________________ Signature ______________________________ Signature INSTRUCTIONS: · Fill in the form on the items: Enterprise structure, Enterprise legal name, and fictitious name (if applicable) ­ do so by clicking in each box and typing in the information. · You can retrieve the Enterprise Legal Name in your confirmation email you received from pao4b@state.pa.us. · If you are just filing a fictitious name, simply fill out the structure and the fictitious name sections. · Print this form and have each owner sign on the signature lines and fill in the date. · See above information where to mail or fax in this form. American LegalNet, Inc. www.FormsWorkFlow.com