Application For Reservation Of Name
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BCA 4.10
FORM
(rev. Aug. 2014)
APPLICATION FOR RESERVATION OF NAME
Business Corporation Act
Secretary of State
Department of Business Services
501 S. Second St., Rm. 350
Springfield, IL 62756
217-782-9520
217-782-6961
Payment must be made by check or money order
payable to Secretary of State.
($25 fee to each name reserved.)
Filing fee $ _________________________ File # ___________________________ Approved: _________________
———— Submit in duplicate ———— Type or Print clearly in black ink ———— Do not write above this line ————
1. Name(s) to be Reserved (for a period of 90 days each):
_____________________________________________________________________________________________
Must contain the word “corporation,” “company,” “incorporated” or “limited,” or contain an abbreviation of such words.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
2. Proposed Corporate Purpose:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
3. Name of Applicant: ______________________________________________________________________________
4. Address of Applicant: ____________________________________________________________________________
_____________________________________________________________________________________________
5. Dated _______________________________ , _____
Month Day
Year
______________________________________________
Signature of Applicant
______________________________________________
Name (type or print)
NOTE:
• If the applicant is an individual, this application must be signed by the applicant.
• If the applicant is a corporation, this application must be signed by a duly authorized officer of the corpora-
tion.
• Upon filing of this document, name(s) will be reserved for a period of 90 days.
Printed by authority of the State of Illinois. January 2015 — 1 — C 156.10
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