Initial List/annual List And State Business License Application Form - Nevada Secretary Of State Page 5

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*230303*
*230303*
ROSS MILLER
Secretary of State
202 North Carson Street
Carson City, Nevada 89701-4201
Customer Order Instructions
(775) 684-5708
Website:
SUBMIT THIS COMPLETED FORM WITH YOUR FILING
USE BLACK INK ONLY - DO NOT HIGHLIGHT
Processing
24-Hour Expedite
Regular
(additional fee included)
Service Requested:
Date:
Name of Entity:
Return to:
Phone:
Contact Name:
Return Delivery:
(email or fax options do not receive a copy via mail; must be ordered separately)
Fax to:
Email to:
Hold for Pick Up
Mail to Address Above
FedEx: Acct #
Other:
(explain below)
Order Description:
(include items being ordered and fee breakdown)*
*PLEASE NOTE: this office keeps the original paperwork. The first file
Total Amount:
stamped copy ordered at the time of filing is at no charge. Each additional
copy is $2.00 per page (plus $30.00 for each certification).
Method of Payment:
Check/Money Order
Credit Card
Trust Account:
(attach ePayment checklist)
Use balance remaining in job #
Nevada Secretary of State Customer Order Instructions
Revised: 1-11-11
Reset

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