Payement Form - Texas Secretary Of State
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1Payment Form
Date of Receipt (for office use).
(Revised 11/11)
Please type or print clearly.
Expedited Handling Requested?
Yes
No
($25 per document; not available for Apostilles, Service of Process, Trademarks, and some other filings)
SHIP TO
Name:
Street:
City:
State:
Zip Code:
Phone:
Fax:
(required for expedited filings)
DOCUMENT TO BE FILED OR REQUEST FOR COPIES/CERTIFICATE
(include name on document and SOS file number if applicable)
PAYMENT
Charge to Credit Card
Card Type:
American Express
Discover
MasterCard
Visa
(mm/yy)
Card No.:
–
–
–
Expires:
Name on Card:
Phone:
Credit Card Billing Address:
Zip Code:
City:
State:
Charge to Secretary of State Client Account No.:
(filings require sufficient funds in client account)
Name on Account:
Charge to LegalEase Account No.:
500679
–
–
–
Client Reference No.:
Case No.:
Fees are calculated based on the secretary of state fee schedule. Fees paid by credit card are subject to a statutorily
authorized convenience fee of 2.7% of the total fees incurred.
Signature:
Date:
Print
Reset
Batch No.:
(for office use)
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