Professional Limited Liability Company

Contact Information

Name

First Last

Email*

Enter Email Confirm Email

Phone*

Name of Professional Limited-Liability Company

Name of Professional Limited-Liability Company:

Registered Agent for Service of Process

Choose one

Commercial Registered Agent
Noncommercial Registered Agent
Office or Position with Entity

Name of Commercial Registered Agent

Name of Noncommercial Registered Agent OR Name of Title of Office or Other Position with Entity

Street Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name and Address of the Original Members and Managers

List of Original Managers

Name	Street Address	City	State	Zip

Management

Company shall be managed by:

Manager(s)
Member(s)

Profession to be Practiced

Name, Address and Signature of Organizer

Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

INITIAL/ANNUAL LIST OF MANAGERS OR MANAGING MEMBERS AND STATE BUSINESS LICENSE APPLICATION OF:

NAME OF LIMITED-LIABILITY COMPANY

ENTITY NUMBER

Filling Period Start Date

Filling Period End Date

CHECK ONLY IF APPLICABLE AND ENTER EXEMPTION CODE IN BOX BELOW

Check if applicable:

Pursuant to NRS Chapter 76, this entity is exempt from the business license fee.

Exemption code:

MANAGER OR MANAGING MEMBER

Name	Address	City	State	Zip Code

Registered Agent Acceptance

Certificate of Acceptance of Appointment by Registered Agent

Name of Represented Business Entity

Name of Appointed Registered Agent OR Represented Entity Serving as Own Agent*

You are a:

Commercial registered agent listed with the Nevada Secretary of State,
Noncommercial registered agent with the following address for service of process
Represented entity accepting own service of process at the following address

Street Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Title of Office or Position of Person in Represented Entity

Street Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

I hereby state that on, I accepted the appointment as registered agent for the above named business entity

Customer Order Instructions

Name of Entity:

Return to:

Contact Name

Phone

Return Delivery

Email
Fax
Hold for Pick Up
Mail to Address Above
FedEx: Acct #
Other

(email or fax options do not receive a copy via mail; must be ordered separately)

Email to:

Fax to:

FedEx: Acct #

Other

please explain

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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