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Payment Form 815 - Texas

Payment Form Form. This is a Texas form and can be used in General Business Secretary Of State .
 Fillable pdf Last Modified 12/15/2011
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Payment Form (Revised 11/11) Date of Receipt (for office use). Please type or print clearly. Expedited Handling Requested? Yes No ($25 per document; not available for Apostilles, Service of Process, Trademarks, and some other filings) SHIP TO Name: Street: City: Phone: Fax: State: Zip Code: (required for expedited filings) DOCUMENT TO BE FILED OR REQUEST FOR COPIES/CERTIFICATE (include name on document and SOS file number if applicable) PAYMENT Charge to Credit Card Card Type: Card No.: Name on Card: Credit Card Billing Address: City: Charge to Secretary of State Client Account No.: (filings require sufficient funds in client account) American Express ­ ­ Discover ­ MasterCard Expires: Phone: Visa (mm/yy) State: Zip Code: Name on Account: Charge to LegalEase Account No.: Client Reference No.: 500679 ­ ­ Case No.: ­ Fees are calculated based on the secretary of state fee schedule. Fees paid by credit card are subject to a statutorily authorized convenience fee of 2.7% of the total fees incurred. Signature: Batch No.: (for office use) Date: American LegalNet, Inc. www.FormsWorkFlow.com
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