Expedited Request By Fax Cover Sheet Form
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1Maryland
SDAT
CORPORATE CHARTER DIVISION
Expedited Request by Fax Cover Sheet
NOTE: All faxed filings and requests are expedited and an expedited filing surcharge beyond the processing fee applies to each request.
See Fee Schedule at for the appropriate fees or e-mail the division at
charterhelp@dat.state.md.us or telephone for new filings only 410-767-1340, for all other calls 410-767-1350.
____________________________________________________________________________________________________
Please type or print legibly, you may also fill this form out on your pc.
Fax all request to: (410) 333-7097
Name of entity:______________________________________________________________________
Fax number: ____________________________________________
Phone number: _______________________________________ Number of pages transmitted:_________
Contact person: _______________________________________________
Name and address for return mail: ____________________________________________________________
___________________________________________________________________________________________________________
Check all that apply
SERVICE REQUESTED
Note a $5.00 fee applies to this service
NEW ENTITY FILING
File document
Return original document
Certified copies of document being filed _____Number of certified copies
Short form Certificate of Status
______Number of certificates
RECORD REQUEST
Department ID number____________________________
Entity name________________________________________________________________________
Certificate of Status for existing entity
_____Number of certificates
Copies of documents previously recorded
Attach separate sheet and specify: the name and title of each document; the date of recording, if known; liber and
folio, if known; the number of copies wanted of each document.
__________________________________________________________________________________
CREDIT CARD INFORMATION
MASTERCARD
VISA
(At this time we only accept Mastercard and Visa)
Cardholder’s name______________________________________________________
Credit card number _______________________________________________________________
Expiration date______________________________________
Signature of Cardholder_____________________________________________________________
This transaction will not be accepted without a signature.
=======================================FOR DEPARTMENTAL USE ONLY======================================
AUTH NO.___________________________________CLERK: ___________ FEE:_______________
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