Form Nr-3 - Application For Trade Name (Dba)
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1Natalie E. Tennant
Penney Barker, Manager
Secretary of State
Business & Licensing Division
1900 Kanawha Blvd E
Tel: (304)558-8000
Bldg 1, Suite 157-K
Fax: (304)558-8381
Charleston, WV 25305
Website:
E-mail:
APPLICATION FOR
Office Hours: Monday – Friday
FILE ONE ORIGINAL
8:30 a.m. – 5:00 p.m. ET
(Two if you want a filed date
TRADE NAME (DBA)
stamped copy returned to you)
FEE: $25.00
1. The name of the company applying to
register a Trade Name (DBA) is:
__________________________________________________________
2. The above company is applying to do
business within West Virginia under
the following Trade Name (DBA):
__________________________________________________________
3. The address of the principal office:
Address 1:
____________________________________________
Address 2:
____________________________________________
City/State/Zip: ____________________________________________
4. The name, address, signature
Name:
____________________________________________
and title of the person having
authority to make application:
Street:
____________________________________________
City/State/Zip: ____________________________________________
(If “Yes,” attach page one of the Franchise Agreement.)
5. Is the company operating as a franchise?
Yes
No
6. Contact Person Name: ________________________________________
Contact Phone #: ____________________
7. Signature*: ___________________________________ Title: ___________________ Date:
*Important Legal Notice Regarding Signature:
Corporations/Voluntary Associations/Business Trusts/Unincorporated Nonprofit Associations/Limited Partnerships - Per West Virginia Code
§31D-1-129. Penalty for signing false document. Any person who signs a document he or she knows is false in any material respect and knows that the
document is to be delivered to the Secretary of State for filing is guilty of a misdemeanor and, upon conviction thereof, shall be fined not more than one
thousand dollars or confined in the county or regional jail not more than one year, or both. Limited Liability Companies/Limited Liability
Partnerships - Per West Virginia Code §31B-2-209. Liability for false statement in filed record. If a record authorized or required to be filed under
this chapter contains a false statement, one who suffers loss by reliance on the statement may recover damages for the loss from a person who signed the
record or caused another to sign it on the person's behalf and knew the statement to be false at the time the record was signed.
BEFORE you fill out the application: The name you select will be approved only if it is available—that is, if the name is not the same as and
is distinguishable from any other name which has been reserved or filed with the Secretary of State. Before you prepare this application, call the
Business & Licensing Division at (304)558-8000 to find out if the name you have chosen is available. A telephone check on availability of a
name is not a guarantee, but it will help find a name you can use. As required by
§47-8-4
of the West Virginia Code, corporations, associations,
limited partnerships, limited liability partnerships, business trusts, and limited liability companies may not conduct business under a trade name
or assumed name without first filing an application for registration of trade name with the Secretary of State.
Franchises: If filing as part of a Franchise, you must include a copy of the first page of the Franchise Agreement with this application.
The application will be returned to you as incomplete if page one of the Franchise Agreement is not attached.
Important Note: This form is a public document. Please do NOT provide any personal identifiable information on this form such as social
security number, bank account numbers, credit card numbers, tax identification or driver’s license numbers.
SEND THE APPLICATION TO THE ADDRESS AT THE TOP OF THE APPLICATION
FILING FEE -- $25 Make checks payable to West Virginia Secretary of State.
Form NR-3
Issued by the Office of the Secretary of State
Revised 11/14
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