Free Department of the Secretary of State - Maine

Department of the Secretary of State Bureau of Corporations, Elections and Commissions
If you wish to pay for filing fees or other services offered by this Bureau with your credit card, please complete the following credit card payment voucher and submit it with your request. Check the appropriate box: Visa MasterCard Credit Card No.: _______________________________________________________ Expiration Date: Name (as it appears on card): ____________________ (mm/yy) _______________________________________________________

(Please use the address to which your credit card bills are sent.) Address (No. and Street): Address (Apt. or Suite): Town: State: Zip Code: _______________________________________________________ _______________________________________________________ _____________________________ ____________________ ____________________

________________________________________________________ Cardholder's Signature

________________ Date

Daytime Telephone Number: _________________________________