Dba / Assumed / Fictitious Name Filing
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PLEASE SELECT
Entity Type: Please select the Entity Type: Sole Proprietor, Partnership, S-Corporation, Corporation
Single Member LLC, Multi-Member LLC.
Select State: Please indicate the State in which you would like to register your DBA / Assumed
or fictious name.
Important: If you have an existing CORPORATION/LLC and wish to file DBA in a state
other than your home state, First "FOREIGN QUALIFY" the CORPORATION/LLC in order to file the DBA. Pelase
contact our officetoll-free at 1-866-754-4460 for further assistance.
Select State* :
-- Select State -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Select County* :
-- Select County --
Type of Entity* :
-- Select Entity Type --
Sole Proprietor
S-Corporation
Corporation
Single Member LLC
Multi-Member LLC
ORDER INFORMATION
PLEASE SELECT SUBSCRIPTION TYPE
Subscription Type:
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CONTACT INFORMATION (This is where we will ship your documents)
First Name* :
Last Name* :
Address* :
Suite/Apt:
City* :
State* :
-- Select State -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip* :
(99999) OR (99999-9999)
Phone* :
Fax:
BUSINESS OVERVIEW
Name of Entity: Please enter the company name exactly as it appears on your
state-approved formation documents.
State of Formation: Please indicate your home state in which you are organized or incorporated.
Date of Formation: Please enter the exact date your entity was formed, the date
should be exactly as it appears on your state approved formation documents.
Brief Business Description: Please provide a business description that briefly describes the
principal business activity. A single sentence or two is all that is required.
Please indicate the County in which you would like to register your DBA. -- Select County --
Please select DBA County.
Brief Business Description* :
OWNERS' INFORMATION
OWNER 1
Copy from Contact Information if same
Full Name* :
Social Security Number* :
(999-99-9999)
Date of Birth:
(mm/dd/yyyy)
For State of UT only
Residence Address* :
City* :
State* :
-- Select State -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip* :
(99999) OR (99999-9999)
PAYMENT INFORMATION
Same as Contact Information
First Name* :
Last Name* :
Billing Address* :
City* :
State* :
-- Select State -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip* :
(99999) OR (99999-9999)
Phone* :
Fax:
Card Type* :
-- Select One --
Visa
Mastercard
Discover
American Express
Expiration Date* :
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Card Number* :
Card Security Code* :
Please use the security code as follow:
1. Master Card- Please insert 3 digits security code from the back of the card
2. Visa Card- Please insert 3 digits security code from the back of the card
3. Discover Card- Please insert 3 digits security code from the back of the card
4. American Express- Please insert 4 digits security code from the front of American Express
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