COMMONWEALTH OF VIRGINIA STATE CORPORATION COMMISSION SCC631/830 (03/08) APPLICATION FOR RESERVATION OR FOR RENEWAL OF RESERVATION OF A CORPORATE NAME The undersigned applies, pursuant to the provisions of § 13.1-631 or § 13.1-830 of the Code of Virginia, for (MARK APPROPRIATE BOX): reservation of the following corporate name for a period of 120 days renewal of the reservation of the following corporate name for an additional period of 120 days CORPORATE NAME BEING RESERVED OR RENEWED: __________________________ ___________________________________________________________________________ (see instructions for requirements) THE RESERVED NAME IS FOR A (MARK APPROPRIATE BOX): STOCK CORPORATION Printed name of applicant: NONSTOCK CORPORATION __________________________________________________ (see instructions regarding “applicant”) Printed address: __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ It is a Class 1 misdemeanor for any person to sign a document he or she knows is false in any material respect with intent that the document be delivered to the Commission for filing. See §§ 13.1-612 and 13.1-811 of the Code of Virginia. Signature of applicant or applicant’s authorized agent: __________________________________________________ If the applicant is an entity or the application is signed by an authorized agent of the applicant, the following must be completed: ____________________________________ ________________ (printed name of authorized agent) (title) Phone number of applicant or applicant’s authorized agent (optional): ( ________) __________ – ________________ FOR SCC USE: DCN __________________________ EXP. _____________ R _________________ PRIVACY ADVISORY: Information such as social security number, date of birth, maiden name, or financial institution account numbers is NOT required to be included in business entity documents filed with the Office of the Clerk of the Commission. Any information provided on these documents is subject to public viewing. SEE INSTRUCTIONS ON THE REVERSE American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS TO FORM SCC631/830 The application must be in the English language, typewritten or printed in black, legible and reproducible. The document must be presented on uniformly white, opaque paper, free of visible watermarks and background logos. You can download this form from our website at www.scc.virginia.gov/clk/formfee.aspx. The proposed name must be distinguishable upon the records of the Commission. See § 13.1-630 of the Code of Virginia for a stock corporation and § 13.1-829 of the Code for a nonstock corporation. To check the availability of a corporate name, please contact the Clerk’s Office Call Center at (804) 371-9733 or toll-free in Virginia at (866) 722-2551. Stock Corporations Only: If the name reservation is for a stock corporation (pursuant to § 13.1-631 of the Code of Virginia), then the name shall include the word Corporation, Incorporated, Company or Limited, or the abbreviation Corp., Inc., Co. or Ltd.; provided, however, that the name of a professional stock corporation may include, in lieu of the foregoing, the words professional corporation or a professional corporation or the abbreviation P.C. or PC at the end of the corporate name. See § 13.1-544.1 of the Code of Virginia for a professional corporation and § 13.1-630 of the Code for a stock corporation. See § 13.1-543 of the Code of Virginia for the definition of a professional corporation. The “applicant” is the individual or entity that is the sole holder of the reserved name. A reserved name may be renewed only by or on behalf of the applicant who holds the reserved name. The owner of a reserved corporate name may renew the reservation for successive periods of 120 days each by filing with the Commission, during the 45-day period preceding the date of expiration of the reservation, a renewal application. See § 13.1-631 of the Code of Virginia for a stock corporation and § 13.1-830 of the Code for a nonstock corporation. Important: If the applicant does not indicate whether the name reservation or renewal is for a stock corporation or a nonstock corporation, the application will be processed on the assumption that it is being submitted for a stock corporation. Submit the original, signed application to the Clerk of the State Corporation Commission, P.O. Box 1197, Richmond, Virginia 23218-1197, (Street address: 1300 East Main Street, Tyler Building, 1st Floor, Richmond, Virginia 23219), along with a check for the filing fee in the amount of $10.00, payable to the State Corporation Commission. PLEASE DO NOT SEND CASH. If you have any questions, please call (804) 371-9733 or toll-free in Virginia, (866) 722-2551. NOTE A transfer of a reserved name may be accomplished by submitting to the Clerk’s Office a written notice that sets forth the reserved name and the name and address of the person to whom the name is to be transferred, accompanied by a check in the amount of $10.00 made payable to the State Corporation Commission. The notice must be signed by the applicant for whom the name was reserved or by the applicant’s authorized agent. American LegalNet, Inc. www.FormsWorkflow.com