Form Bca 15.15 - Request Form For Certificates Of Good Standing And Or Copies Of Document

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BCA 15.15
FORM
CORPORATE FAX TRANSMITTAL REQUEST
FORM FOR CERTIFICATES OF GOOD STANDING
AND/OR COPIES OF DOCUMENT
Illinois Business Corporation Act
Secretary of State
Department of Business Services
Corporations Division
501 S. Second St., Rm. 350
Springfield, IL 62756
FAX: 217-524-8281
_____________________________ File #: ______________________________
Date: ___________
Approved: ___________
1. Corporation Name:_______________________________________________________________________________
2. Secretary of State File Number:_____________________________________________________________________
8 digits
Request for:
☐ Expedited Certificate of Good Standing............................................................................................................$45
☐ Expedited Certified Copy of Articles of Incorporation and all amendments (minimum)....................................$75
☐ Expedited Certified Copy of Other Document (set forth below) (minimum)......................................................$75
______________________________________________________________________________________________
Name of Document
Date Filed
In addition to the above fees, an additional 2.35 percent payment processor fee is charged when paying by cred-
it card (minimum $1).
3. Credit Card (SELECT ONE):
☐ Visa
☐ Mastercard
_____________________________________________________________________
Name as it appears on card
☐ Discover
☐ American Express
_____________________________________________________________________
Account Number
Expiration Date
4. Name and Daytime Phone Number of Contact Person:
______________________________________________________________________________________________
Name
Telephone Number
5. Shipment method (SELECT ONE):
(Complete item 6a.)
☐ Regular Mail
(Complete item 6a & 6b.)
☐ United Parcel Service
(Complete item 6c.)
☐ Fax
(Complete item 6d.)
☐ Email
6a. Send to:
_____________________________________________________________________________________
First Name
Middle Name
Last Name
_____________________________________________________________________________________
Number
Street
Apt./Ste. #
_____________________________________________________________________________________
City
State
ZIP Code
6b. UPS Account Number: __________________________________________________________________________
Account Number
Account ZIP Code
6c. Fax to: ________________________________________________________________________________________
Name
Fax Number
6d. Email address: _________________________________________________________________________________
Printed by authority of the State of Illinois. August 2016 - 1 - C 341.2

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