Application For Electronic Funds Transfer Page 2
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1
2BRANCH OFFICE SELECTIONS
Please list the addresses of three Secretary of State offices you will use to process EFT Transactions.
Identify more than one location provides alternatives for transacting business should one of the branch offices
be forced to close unexpectedly. You should consider selecting an Instant Title office as one of your choices, if
this service would be helpful to you.
FIRST CHOICE
Branch Location
Address
City
State
Zip
SECOND CHOICE
Branch Location
Address
City
State
Zip
THIRD CHOICE
Branch Location
Address
City
State
Zip
BFS-152 (02/2011)
Page 2 of 2
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