Our fees increased September 1, 2003. Please review the instruction box on the form for the new fee. Contact Information
Kansas Secretary of State Ron Thornburgh Memorial Hall, 1st Floor 120 S.W. 10th Avenue Topeka, KS 66612-1594 (785) 296-4564 email@example.com www.kssos.org
KANSAS SECRETARY OF STATE
Reservation of Corporate Name
All information must be completed or this document will not be accepted for filing.
The undersigned reserves the following name for corporate use: __________________________________________________
Name to be reserved
Please complete the form, print, sign and mail to the Kansas Secretary of State with the filing fee. Selecting 'Print' will print the form and 'Reset' will clear the entire form.
Do not write in this space
Name of applicant
Street address of applicant
Title (if applicable)
Instructions NOTICE: THERE IS A $25 SERVICE FEE FOR ALL RETURNED CHECKS. 1. The right to a reserved name may be transferred by filing a written consent signed by the original applicant. The name reservation is effective for 120 days. 2. Name reservations may not be renewed. If a reservation is submitted prior to the expiration of a current name reservation, the new reservation will be rejected. 3. Submit this form in duplicate with the $35 filing fee.
Rev. 7/18/03 amc K.S.A. 17-7402