Expedited Service Request {DSCB 15-153}

PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS Expedited Service Request DSCB:15-153(a)(15) (rev. 7/1/2015) *15315* 15315 This form MUST be completed and submitted with EACH expedited request. EXPEDITED REQUESTS MUST BE SUBMITTED IN PERSON. Entity Name: Requestor's Name: _______________________________________ Requestor's Address: _____________________________________ _______________________________________________________ Contact Person:__________________________________________ Phone Number:__________________________________________ Entity Number: Return Document Via: (CHECK ONLY ONE) COUNTER PICKUP EMAIL - Completed filings will be emailed to the email address supplied below. __________________________________ Select the Level of Expedited Service: EXPEDITED SERVICE FEES ARE IN ADDITION TO FILING FEES. Expedited Fee(s): $100.00 $300.00 $1,000.00 SAME-DAY SERVICE (must be received before 10:00 a.m.) THREE-HOUR SERVICE (must be received before 2:00 p.m.) ONE-HOUR SERVICE (must be received before 4:00 p.m.) Payment Method: Deposit Account number ______________________________ Check Credit Card By checking this box, I verify that I have read and understand the policies and procedures for Expedited Services published in the Pennsylvania Bulletin. To the best of my knowledge, the attached document is acceptable for filing as presented to the Bureau. I understand that if this document is not accepted for filing, the expedited service fee and the filing fee(s) are nonrefundable. American LegalNet, Inc. www.FormsWorkFlow.com