Business Name Registration Form

Business Name Registration Form

Recitals

WHEREAS Applicant seeks to register a trade name or fictitious business name for lawful commercial purposes within the jurisdiction identified herein; and

WHEREAS the information provided on this form will be used to create a public record of the trade name, to assist in service of process and consumer notice, and to establish official contact information for the registered name; and

WHEREAS the Applicant certifies that the trade name is not being registered for the purpose of evading the law, infringing rights of others, or in bad faith, and that all statements contained herein are true and complete to the best of the Applicant's knowledge.

Applicant Information

Business Name Details

Proposed Trade Name (DBA):

Entity Type

Select applicable entity type:
Sole Proprietorship
Partnership
Limited Liability Company (LLC)
Corporation
Other:

Date of Formation/Incorporation (if applicable):

Nature of Business

Date First Used in this Jurisdiction:

Agent for Service of Process

Fees and Payment

Filing fee amount:

Payment method: Check/Money Order Credit Card Other

Late fee and collection: A late payment fee equal to the greater of $25 or 1.5% per month on overdue amounts may be charged if required fees are not received within the timeframes established by applicable law. Applicant is responsible for all collection costs, including reasonable attorney fees, if unpaid fees are referred for collection.

Term, Renewal, and Termination

Registration Term: Unless otherwise provided by law, the registration of a trade name shall remain effective for the period required by statute and is renewable in accordance with applicable filing requirements. Applicant must timely apply for renewal and pay required fees to maintain an active registration.

Termination/Withdrawal: Applicant may withdraw this registration in writing. The registering authority may cancel or refuse registration for statutory cause, including but not limited to fraud, infringement of another's rights, or failure to pay required fees.

Confidentiality and Public Record

Applicant acknowledges that information supplied on this form may be retained as part of the public record and may be subject to disclosure under applicable public records law. Personal contact information may be used for official notices, service of process, and enforcement of consumer protection laws. Applicant expressly consents to such disclosures as required by law.

Governing Law; Entire Agreement

This registration and any dispute arising out of or related to it shall be governed by the laws of the jurisdiction in which the trade name is registered, without regard to conflict of law principles. This form constitutes the complete record of the Applicant's registration request and supersedes prior oral or written communications between Applicant and the registering authority concerning the trade name.

Certification and Penalties

By signing below, Applicant certifies under penalty of perjury that the information provided on this form is true, correct, and complete. Applicant acknowledges that knowingly providing false information may subject the Applicant to criminal and civil penalties as provided by law.

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