NAME AND ADDRESS CHANGE FORM BUSINESS ENTITY
NAME AND ADDRESS CHANGE FORM FOR BUSINESS ENTITIES
Name as it Appears on Current License:
Date:
*Federal Employer Identification Number:
License Number(s):
Signature of Designated Licensee:
Printed Name of Designated Licensee:
Preferred Mailing Address:
ADDRESS CHANGE SECTION
City
State
Physical Business Address (street address required):
Zip Code Phone Number: ( )
City New Full Legal Name:
State
Zip Code
NAME CHANGE SECTION*
Attachments Required:
$25.00 check or money order made payable to the Commonwealth of Pennsylvania (fee required only for name change not address change) AND Copy of Form W-9 issued by the Internal Revenue Services, US Dept of Treasury () AND For PA Nonresident Business Entities: PA Dept of State, Corporation Bureau, Amended Certificate of Authority (dos.state.pa.us) OR For PA Resident Business Entities: PA Dept of State, Corporation Bureau, Approved Filing and/or Registration Form (dos.state.pa.us)
*If there is also a change to the FEIN, do not complete this form. Instead, a new Business Entity Application would be required. Please log onto our website insurance. for the proper application procedures.
Office of Market Regulation | Bureau of Licensing & Enforcement | Licensing Services Division 1209 Strawberry Square | Harrisburg, Pennsylvania 17120
Phone: 717.787.3840 | Fax: 717.787.8553 | insurance.
Name and Address Change Form ? Business Entities (Revised 02/10)
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- doing business with the commonwealth us
- 4600 j barry court suite 220 canonsburg pa 15317
- pa 20s pa 65 2006010058 pa s corporation partnership
- name and address change form business entity
- doing business with the commonwealth
- pa 20s pa 65 2106010057 pa s corporation partnership
- steps to order copies of your business registration documents
- the bureau business one pa department of state
- business entity details
- edna and ednav2 user manual
Related searches
- nv business entity search
- tx secretary of state business entity search
- state of nevada business entity search
- name and address worksheets printable
- change logon name and password
- printable name and address sheets
- change microsoft name and password
- new jersey business entity name search
- how to change wifi name and password
- change user name and folder windows 10
- business entity name search delaware
- change business entity with irs