Limited Liability Company

Filing Party

CONFIRMATION WILL BE SENT TO THIS ADDRESS

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Email

Phone

Name of Limited Liability Company

Select three names for the LLC. The name shall contain the words “limited liability company” or “limited company” or the abbreviations “L.L.C.”, “L.C.”, “LLC”, or “LC”

1st Choice*

2nd Choice

3rd Choice

Company Address

Principal Office Address

Street Address Address Line 2 City State ZIP Code

Mailing Address

Street or P.O. Box Address Line 2 City State ZIP Code

Appointment of registered agent

Agent is

An individual
A business

Agent's Full Legal Name

First Middle Last

Agent's Business Address

Street Address City State ZIP Code

Agent's Connecticut Residence Address

Street Address City State ZIP Code

Agent's Connecticut Mailing Address

Street Address City State ZIP Code

Name of business

Full name and title of person signing on behalf of agent

First Middle Last

Connecticut Business Address

Street Address City State ZIP Code

Connecticut Mailing Address

Street Address City State ZIP Code

Manager or Member Information

Full Name

First Middle Last

Title

Member
Manager

Business Address

Street Address Address Line 2 City State ZIP Code

Residence Address

Street Address Address Line 2 City State ZIP Code

Full Name

First Middle Last

Title

Member
Manager

Business Address

Street Address Address Line 2 City State ZIP Code

Residence Address

Street Address Address Line 2 City State ZIP Code

NAICS CODE

Organizer

Contact Information

Name

First Last

Email*

Enter Email Confirm Email

Phone*

Application Fee

Price:

Please select an additional service that you wish to have processed

Priority Request / Rush Processing + $75

Total

$0.00

Consent

I agree

I CERTIFY THAT THE RECITATIONS CONCERNING THE VESSEL: NAME, TONNAGE, DIMENSIONS, PROPULSION, OWNERSHIP, HAILING PORT, RESTRICTIONS, ENTITLEMENTS, REMARKS AND ENDORSEMENTS CONTAINED IN THE CERTIFICATE OF DOCUMENTATION REMAIN ABSOLUTELY THE SAME.

NAME:*

Type your full name to sign this secure webform

Signature*

CAPACITY OF PERSON SIGNING (E.G., AGENT, TRUSTEE, GENERAL PARTNER, CORPORATE OFFICER, MEMBER)

Authorization*

I agree

I agree to pay the above total amount according to the card issuer agreement and hereby authorize the charge for the total amount above for the processing of selected applications. I understand that my application will be processed in the order in which it is received by Corporation Center, a private fee-for-service company, not owned or operated by any governmental agency. I understand that application and processing fees are non-refundable as per Corporation Center’s no refund policy.

Credit Card

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