Dakota Fast File User Authorization Form The following form must be submitted and approved by the Secretary of State for each individual the institution authorizes to use Dakota Fast File. If you have any questions, please contact the UCC Division. Pad Account Number: _______________________ Institution Name: __________________________________________________________________________ Individual’s Name: ________________________________________________________________________ Mailing Address: Phone Number: ____________________________ Email: __________________________________________________________________________________ Please check the system(s) to which the user is authorized. The institution must be subscribed to the selected system in order for individual authorization to be applicable. Search Tickler File UCC Documents I understand I am responsible for preserving the secrecy of the assigned user ID and password. I am liable for any and all charges assessed to the assigned account. Dated __________________________ __________________________________________ (Signature of Individual) Return to: UCC Division Office of Secretary of State 500 E Capitol Avenue, Pierre SD 57501 Phone: 605-773-4422 Fax: 605-773-4550 Email: dakotafastfile@state.sd.us ______________________________________________ (Signature of Authorized Representative) ______________________________________________ (Printed Name) ______________________________________________ (Title) For Office Use Only: ___________________________ ________________________ ___________________________________ Account User Name Password Expiration Date Dakota Fast User Authorization – Revised September, 25 2008 American LegalNet, Inc. www.FormsWorkFlow.com