Submitter’s Information

Mark the appropriate priority box. (additional Expedited Cost)

Submitter’s Information

1. Completely fill out your individual or business/firm name and complete address. The attention line needs to
   be completed if a business or firm name is listed.
2. The account number is only to be completed by entities that have an existing Depository account with
   the Division of Corporations. Please ignore this field if you do not have a Depository account.

Certification Request Information

Complete the name of the entity and the entity File number. If you do not have the file number, you
may leave it blank.

Method of Return Information

All documents are returned Regular Mail unless otherwise specified. Please mark the appropriate
method of return. The Division of Corporations can express mail using Fed-X, UPS, DHL or Airborne.

Credit Card Information

All credit card information must be completed. If the credit card information is not the same as it is listed
with the submitter’s information, then please specify the correct information in the comments/filings
instruction area on the bottom right hand side of the memo. You must also include your 3-4 digit security
code on the back of the card.

Please contact our office at 302-739-3073 with any questions or for verification of fees.