Form 101 - Assumed Business Name-New Registration
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1Phone: (503) 986-2200
Assumed Business Name—New Registration
Fax: (503) 378-4381
Secretary of State
Print
Corporation Division
255 Capitol St. NE, Suite 151
Reset
Salem, OR 97310-1327
Save As
R
N
:
EGISTRY
UMBER
For office use only
In accordance with Oregon Revised Statute 192.410-192.490, the information on this application is public record.
We must release this information to all parties upon request and it will be posted on our website.
For office use only
Please Type or Print Legibly in Black Ink. Attach Additional Sheet if Necessary.
1) A
B
N
SSUMED
USINESS
AME (To be registered)
Registration or filing of a name does not grant exclusive rights or interests in that name. A name may be available for registration; however, someone
else may hold a prior right to that name, or the name may be too similar to another, and may result in a case of legal action brought against the
registrant for dilution or unfair competition of someone else's business.
2) D
B
4) N
A
R
ESCRIPTION OF
USINESS (Primary business activity)
AME OF
UTHORIZED
EPRESENTATIVE (One name only)
3) P
P
B
5) M
A
A
R
RINCIPAL
LACE OF
USINESS (Address, city, state, zip)
AILING
DDRESS OF
UTHORIZED
EPRESENTATIVE
6) R
'
/O
P
A
A
EGISTRANT
S
WNER
UBLICLY
VAILABLE
DDRESS (List name and street address of each person or entity who will conduct or transact business under the
assumed business name.) (Attach a separate sheet if necessary.)
N
S
A
C
/S
/Z
AME
TREET
DDRESS
ITY
TATE
IP
7) C
Baker
Crook
Harney
Lake
Morrow
Union
OUNTIES
Benton
Curry
Hood River
Lane
Multnomah
Wallowa
Clackamas
Deschutes
Jackson
Lincoln
Polk
Wasco
A
C
LL
OUNTIES
(Statewide)
Clatsop
Douglas
Jefferson
Linn
Sherman
Washington
Columbia
Gilliam
Josephine
Malheur
Tillamook
Wheeler
Coos
Grant
Klamath
Marion
Umatilla
Yamhill
8) S
IGNATURES (All registrants/owners must sign.)
FEES
Required Processing Fee
$50
Confirmation Copy (Optional) $5
Processing Fees are nonrefundable.
Please make check payable to
“Corporation Division.”
NOTE:
Fees may be paid with VISA or
MasterCard. The card number and
9) C
N
D
P
N
(
ONTACT
AME (To resolve questions with this filing.)
AYTIME
HONE
UMBER
Include area code.)
expiration date should be submitted
on a separate sheet for your
protection.
101 (Rev. 08/06)
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