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Credit Card-Debit Card Authorization DOS-1515-f-l - New York
| Credit Card-Debit Card Authorization Form. This is a New York form and can be used in General Corporations And Business Entities Secretary Of State . |
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NYS Department of State DIVISION OF CORPORATIONS Credit Card/Debit Card Authorization Attach this form to your document or written request. One Commerce Plaza, 99 Washington Ave. Albany, NY 12231-0001 www.dos.ny.gov Reset Form The Name of Corporation or Other Business Entity To Which This Service Request Applies is: Check Box for Requested Service: FILING OF DOCUMENTS AND CERTIFICATES *Optional Expedited Service for Additional Fee: (Consult appropriate fee schedule for filing fees) 24-Hour-$25 Same-Day-$75 2-Hour-$150 Fill in Fee or Amount: $ $ $ Same-Day-$75 2-Hour-$150 CERTIFIED COPY (The fee for each certified copy is $10.) 24-Hour-$25 *Optional Expedited Service for Additional Fee: $ $ $ $ $ $ $ $ $ PLAIN COPY (The fee for each plain copy is $5.) *Optional Expedited Service for Additional Fee: 24-Hour-$25 Same-Day-$75 2-Hour-$150 CERTIFICATE UNDER SEAL SERVICE OF PROCESS (Certificates of Good Standing, etc. The fee for each certificate is $25.) 24-Hour-$25 Same-Day-$75 2-Hour-$150 *Optional Expedited Service for Additional Fee: (Must be served in person at the above address) BIENNIAL / FIVE YEAR STATEMENT OTHER DEPOSIT TO DRAWDOWN Account Name: TOTAL (Total Amount Due): Account Number: $ *Same day expedited service requests must be received by 12 noon. 2-hour expedited service requests must be received by 2:30 p.m. Expedited service fees are non-refundable and will not be refunded if a filing is rejected. Credit/Debit Card Information: MasterCard Credit Card Number: Expiration Date (Month and Year): Name as it Appears on Credit Card or Debit Card (Print): Cardholder's Billing Address (As listed with Credit Card or Debit Card Company): City: State: Zip Code+4: Visa American Express Cardholder's Signature: If the name on the credit card or debit card is in the name of a corporation or other business entity, please print the signer's name: Daytime telephone number: DOS-1515-f-l (Rev. 04/13) Date: Fax number: American LegalNet, Inc. www.FormsWorkFlow.com
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