Secretary of State Payment Form
|Payment Form | |Date of Receipt (for office use). |
|(Revised 06/23) | | |
| |
|Please select requested processing: |
| |
| |Expedited Handling – Fee is $25 per corporate document/$10 for copies/$15 for UCC |
| |(NOT available for Apostille or Authentication Services, Service of Process, Notary Applications, Trademark Applications, or Regulated Occupation |
| |Applications) |
| |Regular Handling |
|This payment is for: | Notary Application | Trademark Application |
| |Regulated Occupation Application |UCC |
|Authentication/Apostille Service |Service of Process |Other _____________________ |
|Copies | | |
|Corporate Document | | |
| |
| |
|SUBMITTER INFORMATION: |
|Complete all information for the person/company submitting the document to the Office. Corporate documents only: submitter will receive a file stamped copy of the |
|filed document if it is submitted in duplicate. |
| |
|Submitter Name: | |
|Street: | |
|City/State/Zip: | |
|Phone: | |Fax: | |
|Email Address (required for expedited | |
|handling): | |
| |
| |
|DOCUMENT FILING INFORMATION: |
|Complete all information regarding the document that is being submitted to the Office. |
| |
|Entity or applicant name listed on | |
|document: | |
|Entity File # (if applicable): | |
|Type of Document: | |
|Number of Pages: | |
| |
| | |
|PAYMENT INFORMATION: |
|Check the box with your method of payment. Include the necessary information. |
| Check/Money Order Enclosed |Check/Money Order Number: |
| Client Account: For instructions on how to create or fund a client account, visit |
| |Account #: | |
| |Name on Account: | |
| |
| LegalEase |
| |Account #: |500679 - | - - |
| |Client Reference #: | |
| | | |
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