Fill and Sign the Fillable Online Application to Appoint or Change Fax Email Form

FILE ONE ORIGINAL (Two if you want a filed stamped copy returned to you) FEE: $15.00 1. I want to reserve the following name for a period of one hundred twenty (120) days: ___________________________________________________ 2. The name will be used for a ( check one): Corporation Limited Liability Company Limited Partnership Business Trust Voluntary Association Limited Liability Partnership 3. The person or company reserving this name intends to ( check one): 4.The name and address of the Name: _______________________________________ applicant (person or company) is: Street: Street Address:_______________________________________ City/State/Zip: _______________________________________ 5. Signature information (see *Important Legal Notice Regarding Signature in the attached instructions): Signature: ____________________________________ Date:______________________________ Title : Important Note: This form is a public document. Please DO NOT provide any personal identifiable information on this form such as social security numbers, bank account numbers, credit card \ numbers, tax identification or driver’s license numbers. ACKNOWLEDGEMENT (For office use only) TO THE APPLICANT: The name is reserved for the exclusive use of the applicant for one hundred twenty (120) days beginning ______________________ and ending ___________________________ . The name is NOT available (see attached name conflict), and the application is accordingly deni\ ed. BY:_____________________________________ Business & Licensing Clerk Change existing (present) company name. Organize as a West Virginia company . Qualify as a foreign company in West Virginia –the o riginal state of registration is ______________________________ ______________________________ APPLICATION FOR NAME RESERVATION Form NR-1 Rev. 12/2018 West Virginia Secretary of State Business & Licensing Division Tel: (304)558-8000 Fax: (304)558-8381 Website: www.wvsos.gov Phone Number: E-mail Address: INSTRUCTIONS FOR FILING APPLICATION FOR NAME RESERVATION BEFORE you fill out the application: The name you select will be approved only if it is available --that is, if the name is not the same as and is distinguishable from any other name which has been reserv\ ed or filed. Before you prepare this application, call the Corporations Division at (304)558-8000 to find out if the name you hav\ e chosen is available. A telephone check on availability of a name is NOT a guarantee, but it will help find a name you can use. Once your name reservation application is approved, you are guaranteed exclusive use of the name for 120 days, enough time t\ o prepare and submit the actual filing to establish or authorize the type of business you will form. FILLING OUT THE APPLICATION: 1) The requirements for the name of the new company depends on the laws for\ each company type. All company types The name may not contain any word or phrase which implies that it is org\ anized for any purpose other than the stated purpose of the company. The terms “banking” and/or “insurance” cannot be used in the\ business name if the business activity does not include “banking” and/or “insurance.\ ” Words such as “engineer” or “engineering” may only be used i\ f the purpose is to practice professional engineering and one of the principals is a registe\ red WV professional engineer. Some licensed professions have specific requirements and prohibitions. The term “911” is prohibited. Any company which is not a corporation may not use the corporate terms l\ isted below. Corporation The name must include one of these words or abbreviations: Incorporated; Corporation; Company; Limited; Inc.; Corp.; Co.; Ltd. Limited Liability The name must include one of these terms or abbreviations: Company Limited Liability Company; Limited Company; L.L.C.; LLC; L.C.; LC; Ltd. \ Co. “Professional” companies must first obtain board approval for the \ name and must use either: Professional Limited Liability Company; Professional L.L.C.; Professiona\ l LLC; P.L.L.C.; PLLC Limited Liability The name must include one of these terms or abbreviations: Partnership Registered Limited Liability Partnership; L.L.P.; LLP Limited Partnership The name must include one of these terms or abbreviations: Limited Partnership; Ltd. Partnership; L.P.; LP The name may not contain the name of a limited partner unless that perso\ n or company is also a general partner, or unless the business has been carried on un\ der the name before that limited partner was admitted. Voluntary Association May not include any term indicating it is incorporated. & Business Trust 2) Sole Proprietorships, General Partnerships and/or Joint Ventures may not\ reserve a name with the Secretary of State. These types of business structures form through the West Virginia State \ Tax Department. Check the type of company you plan to form, and make sure the name you propose meets those requirement\ s. 3) Check the reason you are reserving the name. 4) When you are ready to register the company, the person who signs as the \ applicant to reserve the name will be required to file the company formation documents with Secretary of State. The applicant \ is essentially the owner of the name for 120 days. The applicant should be a principal of the company. 5)Signature of the applicant and Date the application is signed. *Important Legal Notice Regarding Signature: Corporations/Voluntary Associations/Business Trusts/Unincorporated Nonpr\ ofit Associations/Limited Partnerships - Per West Virginia Code §31D-1-129. Penalty for signing false document. Any person who signs a document he or she knows is false in any material respect and knows that the document is to\ be delivered to the Secretary of State for filing is guilty of a misdemeanor and, upon conviction thereof, shall be fined not\ more than one thousand dollars or confined in the county or regional jail not more than one year, or both. Limited Liability Companies/Limited Liability Partnerships - Per West Virginia Code §31B-2-209. Liability for false statement in filed record. If a record authorized or required to be filed under this chapter contains a false statement, one who suffers loss by r\ eliance on the statement may recover damages for the loss from a person who signed the record or caused another to sign it on\ the person's behalf and knew the statement to be false at the time the record was signed. Note: A reserved name may be transferred from any other person or company by \ filing with the Secretary of State a “Notice of Transfer” executed by the applicant for whom the name was reserved, s\ pecify the name and address of the transferee. Important Note: This form is a public document. Please DO NOT provide any personal identifiable information on this form such as social security number, bank account numbers, credit card number\ s, tax identification or driver’s license numbers. Filing Fee - $15 - Make checks payable to the West Virginia Secretary of\ State. SUBMIT THE COMPLETED APPLICATION ALONG WITH PAYMENT TO ONE OF THE BUSINESS CENTERS LISTED IN THE ATTACHED FILING SUBMISSION INSTRUCTIONS. CHOOSE ONE OF THE FOLLOWING PROCESSING SERVICES: 1 EXPEDITED SERVICE (24-hour, 2-hour and 1-hour; *Requires standard filing fee plus additional expedite fee, see below) West Virginia Secretary of State Business & Licensing Division Tel: (304) 558-8000 Fax: (304) 558-8381 Website: www.wvsos.gov Filing Submission Instructions - Business Division SUBMIT THE COMPLETED APPLICATION WITH THE CUSTOMER ORDER REQUEST FORM TO ONE OF THE OFFICES BELOW. CHOOSE EXPEDITED OR STANDARD PROCESSING SERVICE. IF NOT U\ SING THE CUSTOMER ORDER REQUEST FORM AND YOU ARE REQUESTING EXPEDITED SERVICE, YOU MUST IN\ CLUDE THE WORD "EXPEDITE" AND THE LEVEL OF EXPEDITED SERVICE BEING REQUESTED (24-HOUR,\ 2-HOUR OR 1-HOUR) IN YOUR CORRESPONDENCE. BE SURE TO INCLUDE THE CORRECT ADDITIONAL EXPEDITED\ FEE. THIS FEE IS IN ADDITION TO THE REGULAR FILING FEE ( SEE FEES BELOW). BUSINESS SERVICE CENTERS Standard and Expedited Filings Charleston Office One-Stop Business Center 1615 Washington Street East Charleston, WV 25311 Phone: (304) 558-8000 Fax: (304) 558-8381 Hours: Mon. - Fri. 8:30a - 5:00p EST Clarksburg Office North Central WV Business Center 200 West Main Street Clarksburg, WV 26301 Phone: (304) 367-2775 Fax: (304) 627-2243 Hours: Mon. -Fri. 9:00a - 5:00p EST IMPORTANT: READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING FORMS. Please follow the instructions included with the application. Failure to\ include any of the required information on the form may cause the filing to be rejected. All forms may be downloaded from our web site www.wvsos.gov . Rev. 9/2018 *Fee $ 25.00 $250.00 $500.00 Expedite Service 24-Hour 2-Hour 1-Hour EXPEDITED SERVICE requests may be submitted by: - E-mail to efilings@wvsos.gov - Fax - Walk in delivery 2 STANDARD PROCESSING (5-10 business days) SUBMIT COMPLETED FILING TO ONE OF THE BUSINESS CENTERS BELOW: INCLUDE PAYMENT: Be sure to enclose the correct filing fee with your filing. If paying by\ credit card, be sure to include the e-Payment Authorization form with your filing. Your filing will be rejected if the payment is not included or if the e-\ Payment Authorization form is not included if paying by credit card. Standard filing fees apply. STANDARD PROCESSING requests may be submitted by: - E-mail to CorpFilings@wvsos.gov - Fax - Walk in delivery (drop off service only filed within 5-10 business da\ ys) Martinsburg Office Eastern Panhandle Business Center 229 E. Martin Street Martinsburg, WV 25401 Phone: (304) 356-2654 Fax: (304) 260-4360 Hours: Mon. - Fri. 9:00a - 5:00p EST READ CAREFULLY BEFORE SUBMITTING - Expedite service is NOT AVAILABLE for the following filings: West Virginia Secretary of State Business & Licensing Division Tel: (304)558-8000 Fax: (304)558-8381 Website: www.wvsos.gov Customer Order Request SUBMIT THIS COMPLETED FORM WITH YOUR FILING. Order Processing Requested*: * * * Expedite Processing Requires Additional Fees * * * \ Standard Processing** 24-HOUR Expedite *** 2-HOUR Expedite 1-HOUR Expedite Name of Entity: Return filing to: (Return Address) Contact Name: Phone: Return Delivery Options: Email or Fax options do not receive a copy via mail; must be ordered separately. Email to: Fax to: Hold for Pick Up UPS: Acct # Other (explain below): (additional $500.00 fee included) (additional $25.00 fee included) (additional $250.00 fee included) FedEx: Acct # Mail to Return Address above Order Description (include items being ordered and fee breakdown): * PLEASE NOTE: Original paperwork is kept by this office. Include a copy of the origin\ al filing if you want a file stamped copy returned to you at no extra charge. Certified copy requests are an additional $15 per certified copy being requested. Total Amount: Payment Method: Cash (Do Not mail cash) Pre-paid Acct #: Credit Card (Must attach e-Payment Authorization request form including payment information. ) Check/Money Order *"Processing" indicates the filing will be completed and registered in th\ e Secretary of State registration database. **Standard Processing applications received by E-MAIL or FAX must include the e-Payment Authorization form with credit card informati\ on. ***NOTE: Orders filed in person through any Secretary of State office location \ requesting the filing be processed will be assessed a 24-HOUR Expedite fee of $25.00 per order. (Avg. processing turnaround 5-10 business days ) Rev. 9/2018 Attach signed pre-paid slip. >> Tax Department filings including Sole Proprietorships, General Partnersh\ ips, and Associations >> Dissolution or Withdrawal of Corporation, Voluntary Association or Busi\ ness Trust Email to: CorpFilings@wvsos.gov Email to: eFilings@wvsos.gov 24-hour, 2-hour and 1-hour Expedite Service Guidelines MAC WARNER Secretary of State State Capitol Building Charleston, WV 25305 Phone: (304) 558-6000 Website: www.sos.wv.gov IMPORTANT: To ensure expedited service, please mark “EXPEDITE” in\ a conspicuous place at the top of the service request. Please indicate method of delivery. 24-HOUR EXPEDITE SERVICE The Secretary of State offers a 24-hour expedite service on most busines\ s organization filings processed by this office. If you choose to utilize this service, please enclose with your filing the \ additional expedite fee. Please note that this expedite fee is in addition to the standard fee charged on each filing and/or ord\ er. You must mark the document with your “ 24-HOUR EXPEDITE” request. If using a cover letter, note that you are requesting 24-hour \ expedited service, and include your telephone number and return information. Each filing will be returned b\ y U.S.P.S. regular mail unless other arrangements are made. This office does not fax confirmation of a 24-hour expedite. The fee for 24-hour handling is $25.00 in addition to the usual fee for \ service. Please consult our fee schedules for the appropriate fee. If you require assistance, please contact this office.\ Time Constraints: Under most circumstances, each filing submitted receives same day fili\ ng date and may be picked up in the office by the end of the same business day. Filings to be mailed th\ e next business day if received by 2:00 pm of receipt date and no later than the 2nd business day if received after 2:00 pm. \ Expedite period begins when filing or service request is received in this office in acceptable fileable form . 2-HOUR EXPEDITE SERVICE The Secretary of State offers a 2-hour expedite service on most filings \ processed by this office. If you choose to utilize the 2-hour expedite service, please enclose with your filing an additional $\ 250.00 per filing and/or order. Please note that this expedite fee is in addition to the standard fee charged on each filing a\ nd/or order. Complete and submit the 2-hour customer order instruction form. If not using our order form, state cle\ arly in your cover letter that you are requesting 2-hour expedited service and include your telephone number and return informati\ on. Attach the order form or cover sheet to the top of your filing and submit to this office. Each filing will be returned\ by U.S.P.S. regular mail unless other arrangements are made. 1-HOUR EXPEDITE SERVICE The Secretary of State offers a 1-hour expedite service on most filings \ processed by this office. If you choose to utilize the 1-hour expedite service, please enclose with your filing an additional $\ 500.00 per filing and/or order. Please note that this expedite fee is in addition to the standard fee charged on each filing a\ nd/or order. Complete and submit the 1-hour customer order instruction form. If not using our order form, state cle\ arly in your cover letter that you are requesting 1-hour expedited service and include your telephone number and return informati\ on. Attach the order form or cover sheet to the top of your filing and submit to this office. Each filing will be returned\ by U.S.P.S. regular mail unless other arrangements are made. 1-Hour and 2-Hour Time Constraints: Each filing submitted for either 1-hour or 2-hour expedite receives same\ day filing date and will be acknowledged by fax or e-mail within expedite service t\ ime. Failure to indicate method of acknowledgement (fax or e-mail) or to provide a correct fax number or e-mail address m\ ay prevent the Secretary of State from acknowledging the filing of such documents. Filings may be picked up within the exped\ ite service period. Filings to be mailed will be mailed out no later than the next business day following receipt. Expedite per\ iod begins when filing or service request is received in this office in fileable form. The Secretary of State reserves the right to extend the expedite period \ in times of extreme volume, staff shortages or equipment malfunction. These extensions are \ few and will rarely extend more than a few hours. WV Secretary of State Expedite Guidelines Effective: 8-31-17 e-Payment Authorization Credit Card Number: Card Type: Service Type: Fax Mail E-mail Visa Mastercard Discover American Express Payment Information Storage Authorization Year: Entity Name: Name as it appears on the account Billing Address City State Zip Code Telephone Ext. I authorize the Secretary of State to store this payment information for\ future payment transactions processed by Secretary of State: Authorized Signature X (required) (optional) Date This document contains confidential financial information and will be pr\ operly shredded after payment has been processed by this office. Electronic storage of payment informa\ tion is only permitted by signed authorization below which may be retracted at any time by written reques\ t by the authorized party. Not to Exceed Amount: USD $ Date Month: V Code* * 3-digit number on back of VISA, MasterCard and Discover cards. 4-digit number on front right side of American Express card. NOTICE: For security and verification purposes, all credit card payments must in\ clude the 3- or 4-digit CVV2 code (V Code) number located on the credit card. Failure to include this code will result in \ the rejection of your filing or service request. Rev. 11/2017 West Virginia Secretary of State Business & Licensing Division Tel: (304)558-8000 Fax: (304)558-8381 Website: www.wvsos.gov USE BLACK INK ONLY - DO NOT HIGHLIGHT Payment by Card (card holder name and billing address required below) Credit Card Expiration Date: Amount to Charge Card: USD $ Order Information (required) Card Holder Information: Payment Authorization I authorize the Secretary of State to bill an amount not to exceed the f\ ollowing to be charged to the above listed account(s): Authorized Signature X