Fillable Business Name Registration / Dba Application Form printable pdf download

Instructions

This form must be type written or computer generated.

State of Utah

Non-Refundable Processing Fee:

[ ] New Filing

$22.00

DEPARTMENT OF COMMERCE

[ ] Applicant/Owner Transfer

N/A

Division of Corporations & Commercial Code

Business Name Registration / DBA Application

Print Form

Clear Form

WARNING:

The filing of this application and its approval by the Division of Corporations and Commercial Code does not authorize the use

in the state of Utah of an assumed name in violation of the rights of another under federal, state, or common law (U.C.A. Section 42-2-5 Et seq.).

You may file this application in person or mail or fax to the Division of Corporations (please file in duplicate). If mailing, please include one (1)

self-addressed stamped envelope with application. If you are faxing you must include, on a cover sheet, the number of a Visa, Mastercard or

American Express with the date of expiration. Other means of payment are check, cash or money order.

*If adding or removing an Applicant/Owner, which will affect its status as a General Partnership or Sole Proprietorship, you must submit a

Registration Information Change Form.

Link to DBA Transfer form

*If you want a new name (adding or changing the existing name), a new DBA filing is required.

Business Information

Requested Business Name:

Business Purpose:

Business Address:

_____________________________________________________________________

City: _____________________________________ State: ___________ Zip: _______________

Registered Agent:

Signature:

Registered Agent must sign here after the form is printed

Registered Address:

____________________________________________________

Utah Street Address Required, PO

____________________________________________________

Boxes can be listed on the line

below the Street Address

City: _____________________________________ State: ___________ Zip: _______________

Applicant/Owner:

(The registered agent will be recorded as the applicant/owner if this section is left blank)

List the individual or business

Name: ___________________________________________________________________________

entity that will own the DBA on

Entity Number (if a registered business): ________________________________________________

the name line.

Address: _________________________________________________________________________

City: ______________________________________________ State: ________ Zip: ____________

Under penalties of perjury, I declare that this DBA Application has been examined by me and is, to the best

of my knowledge and belief, true, correct and complete.

Sign here after the form is printed

Signature:

Applicant/Owner:

Name: ___________________________________________________________________________

List the individual or business

Entity Number (if a registered business): ________________________________________________

entity that will own the DBA on

the name line.

Address: _________________________________________________________________________

City: ______________________________________________ State: ________ Zip: ____________

Under penalties of perjury, I declare that this DBA Application has been examined by me and is, to the best

of my knowledge and belief, true, correct and complete.

Sign here after the form is printed

Signature:

IF NEEDED, YOU MAY USE AN ATTACHED SHEET FOR ADDITIONAL APPLICANTS

Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes,

you may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity

Mailing/Faxing Information:

Division's Website:

Business Name Registration / Dba Application Form

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