Free Form - Nevada

ROSS MILLER Secretary of State 202 North Carson Street Carson City, Nevada 89701-4201 (775) 684 5708 Website: www.nvsos.gov
SUBMIT THIS COMPLETED FORM WITH YOUR FILING

Customer Order Instructions
USE BLACK INK ONLY - DO NOT HIGHLIGHT

Processing Service Requested:
Name of Entity:

Regular

24-Hour Expedite

(additional fee included)

Date:

Return to: Contact Name: Return Delivery: Email to: Hold for Pick Up Other: (explain below) Mail to Address Above Phone:
(email or fax options do not receive a copy via mail; must be ordered separately)

Fax to: FedEx: Acct #

Order Description: (include items being ordered and fee breakdown)*

*PLEASE NOTE: this office keeps the original paperwork. The first file stamped copy ordered at the time of filing is at no charge. Each additional copy is $2.00 per page (plus $30.00 for each certification).

Total Amount:

Method of Payment: Check/Money Order eCheck/Credit Card (attach checklist) Trust Account:

Use balance remaining in job # Reset
Nevada Secretary of State Customer Order Instructions Revised: 9-26-08