Application For Registration Of Foreign Llc - Nevada Secretary Of State Page 8
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ROSS MILLER
Secretary of State
202 North Carson Street
ePayment Checklist
Carson City, Nevada 89701-4201
(775) 684-5708
(For Counter, Fax and Mail Requests)
Website:
USE BLACK INK ONLY - DO NOT HIGHLIGHT
Service Type:
Counter
Fax
Mail
Order Processing Requested:
(Expedite Processing Requires Additional Fees)
Regular Processing
24-HOUR Expedite
2-HOUR Expedite
1-HOUR Expedite
Payment by Card
(card holder name and billing address required below)
Card Type:
American Express
Discover
VISA
MasterCard
Customer Credit Card Number:
*
V CODE
* 3-digit number found on the far right of the backside of VISA, MasterCard and Discover cards
4-digit number found on the front right side of American Express card.
NOTICE: For security and verification purposes, all credit card payments must include the 3 or 4-digit CVV2 code
(VCode) number located on the credit card. Failure to include this code will result in the rejection of your filing or service
request.
Credit Card Expiration Date:
Month
Year
Amount to Charge Card:
USD $
Order Information (required)
Entity Name/Order Reference:
Card Holder Information:
Name as it Appears on the Account
Billing Address
City, State, Zip
Telephone
Payment Authorization
I authorize the Secretary of State to bill an amount not to exceed the following to be charged to the above listed
account(s):
X
Not to Exceed Amount:
USD $
Authorized Signature
Nevada Secretary of State ePayment Checklist
Revised: 11-19-10
Reset
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