Form Llp 2007 - Foreign Limited Liability Partnership Registration Package Of Forms With Instructions - State Of Nevada Page 6

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ROSS MILLER
ePayment Checklist
Secretary of State
202 North Carson Street
(For Counter, Telephone, Fax and
Carson City, Nevada 89701-4201
(775) 684 5708
Mail Requests)
Website: nvsos.gov
USE BLACK INK ONLY - DO NOT HIGHLIGHT
Service Type:
Counter
Telephone
Fax
Mail
Order Processing Requested:
(Expedite Processing Requires Additional Fees)
Regular Processing
24-HOUR Expedite
2-HOUR Expedite
1-HOUR Expedite
Payment by Electronic Check
(account holder name and address required below)
Account Type;
Routing Number:
Checking
Account Number:
Savings
Amount of Electronic Check:
USD $
Payment by Card
(card holder name and billing address required below)
Payment Type:
Credit:
Card Type:
VISA
MasterCard
Discover
American Express
Customer Credit Card Number:
*
V CODE
* 3-digit number found on the far right of the backside of VISA, MasterCard and Discover cards
4-digit number found on the front right side of American Express card.
NOTICE: For security and verification purposes, all credit card payments must include the 3 or 4-digit CVV2 code
(V Code) number located on the credit card. Failure to include this code will result in the rejection of your filing or
service request.
Credit Card Expiration Date:
Month
Year
Amount to Charge Card:
USD $
Order Information (required)
Entity Name/Order Reference:
Account/Card Holder Information:
Name as it Appears on the Account
Billing Address
City, State, Zip
Telephone
Payment Authorization
I authorize the Secretary of State to bill an amount not to exceed the following to be charged to the above listed
account(s):
X
Not to Exceed Amount:
USD $
Authorized Signature
Nevada Secretary of State Form ePayment Checklist
Reset
Revised: 4-24-08

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