Application For Name Reservation {210}

Phone: (503) 986-2200 Fax: (503) 378-4381 Application for Name Reservation Secretary of State Corporation Division 255 Capitol St. NE, Suite 151 Salem, OR 97310-1327 FilingInOregon.com REGISTRY NUMBER : In accordance with Oregon Revised Statute 192.410-192.490, the informati on on this application is public record. We must release this information to all parties upon request and it will be posted on our website.r For office use only Please Type or Print Legibly in Black Ink. Attach Additional Sheet if Necessary. 1) THE UNDERSIGNED APPLIES TO RESERVE THE FOLLOWING NAME FOR THE PERIOD OF 120 DAYS . (Reserving a name does not allow an individual to conduct business under this name.) Note: Use the appropriate designation for the entity type. Business Corporations: Corporation, Incorporated, Limited, Company, Corp., Inc., Ltd., or Co. Professional Corporations: Professional Corporation, Prof. Corp., or P.C. Cooperative Corporations: Cooperative or Co-op (not required). Nonprofit Corporations: No corporate designation required. Limited Partnerships: Limited Partnership (without abbreviation). Limited Liability Companies: Limited Liability Company or L.L.C. 2) APPLICANT S NAME AND ADDRESS 3) MAILING ADDRESS (If different) 4) EXECUTION Signature Printed Name Title 5) CONTACT NAME (To resolve questions with this filing.) DAYTIME PHONE NUMBER (Include area code.) FEES Required Processing Fee $50 Confirmation Copy (Optional) $5 Processing Fees are nonrefundable. Please make check payable to Corporation Division. NOTE: Fees may be paid with VISA or MasterCard. The card number and expiration date should be submitted on a separate sheet for your protection. 132 (Rev. 1/04)