Legal Name Reservation Form

LEGAL NAME RESERVATION FORM

This Legal Name Reservation Form is submitted by Applicant Name: , Applicant Title: , on behalf of Entity Name (if applicable): .

Contact Email:    Contact Phone:

RECITALS

WHEREAS, Applicant seeks to reserve for its exclusive use a corporate or business name for the purpose of preventing registration of confusingly similar names while Applicant completes organizational or statutory filing requirements; and

WHEREAS, Applicant has submitted the proposed name(s) below and represents that the proposed name(s) are not reserved, registered, or in active use in a manner that would prevent reservation under applicable naming rules; and

WHEREAS, Applicant requests the reservation for the period and subject to the terms set forth in this form.

NOW, THEREFORE

In consideration of the submission and the representations made herein, Applicant requests reservation of the following name(s) and agrees to the terms and conditions set forth in the numbered provisions that follow.

1. RESERVED NAME(S)

2. ENTITY TYPE

Select the entity type for which this name is intended:

Corporation Limited Liability Company (LLC) Partnership Sole Proprietorship Other:

3. RESERVATION PERIOD

Applicant requests that the reservation be effective commencing on: . Unless extended in writing by mutual agreement, the reservation shall remain in effect for a period of days/months from the effective date indicated above, subject to applicable rules and payment of any required fees.

4. EFFECT OF RESERVATION; LIMITATIONS

During the reservation period set forth in Section 3, the reserved name(s) shall be held for the exclusive filing use of Applicant and shall be protected from acceptance for use by other filers subject to the applicable naming rules. Reservation of a name does not:

(a) confer any proprietary right or trademark right in the name; (b) authorize Applicant to use the name in any other jurisdiction; or (c) substitute for compliance with any statutory or regulatory filing requirement necessary to form or operate the entity described above.

5. CANCELLATION; WITHDRAWAL; REFUSAL

The reservation may be cancelled by the reserving authority if Applicant fails to comply with applicable rules, fails to pay any required fee, or if the reserved name is determined to be prohibited or confusingly similar to an existing name. Applicant may withdraw this request in writing prior to the effective date. If a reserved name is refused, Applicant will be notified and any fees paid may be handled according to the authority's refund policy.

6. FEES AND PAYMENT

Applicant acknowledges that reservation is contingent upon receipt of the required fee. Applicant confirms that payment is submitted with this form: Fee enclosed/submitted. If payment is not received, the reservation request may be returned or denied.

7. CERTIFICATIONS AND REPRESENTATIONS

By signing below, Applicant certifies under penalty of perjury that the information provided in this form is true and correct to the best of Applicant's knowledge, that Applicant has authority to request reservation of the name(s) specified, and that the name(s) are not reserved by another party to Applicant's knowledge. Applicant further acknowledges that false statements may subject Applicant to penalties provided by law.

8. NOTICES

All notices and communications required or permitted under this reservation shall be in writing and delivered to the contact information provided above or to the notice recipient below.

9. AMENDMENTS; WAIVER

This reservation may be amended only by a written instrument signed by Applicant and an authorized representative of the reserving authority. No waiver of any provision of this form shall be effective unless in writing signed by the party against whom enforcement is sought.

10. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This form shall be governed by and construed in accordance with the laws applicable to name reservation matters. This form constitutes the entire understanding between Applicant and the reserving authority concerning the subject matter hereof and supersedes all prior discussions and agreements. If any provision of this form is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

11. AUTHORIZED AGENT (IF APPLICABLE)

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