Application For Certificate Of Authority (For Profit)
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APPLICATION FOR CERTIFICATE
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OF AUTHORITY (For Profit)
(Instructions on Back of Application)
The undersigned Corporation applies for a Certificate of Authority and states as follows:
1. The name of the corporation is:
2. The name which it shall use in Idaho is:
3. It is incorporated under the laws of:
4. Its date of incorporation is:
5. The address of its principal office is:
6. The address to which correspondence should be addressed, if different from item 5, is:
7. The street address of its registered office in Idaho is:,
and its registered agent in Idaho at that address is:
8. The names and respective business addresses of its directors and officers are:
Title
Business Address
Name
Office
Address
____________________________
___________________
__________________________________
____________________________
___________________
__________________________________
____________________________
___________________
__________________________________
____________________________
___________________
__________________________________
____________________________
___________________
__________________________________
____________________________
___________________
__________________________________
Customer Acct # :
Dated:
(if using pre-paid account)
Secretary of State use only
Signature:
Typed Name:
Capacity:
[The signer must be a director or an officer of the corporation.]
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Parent category: Business