Request for Special Search (Business Registry) {601}

Phone: (503)986-2200 Fax: (503)986-2308 Business Registry - Request for Special Search Secretary of State - Corporation Division - 255 Capitol St. NE, Suite 151 - Salem, OR 97310-1327 ­ http://www.FilingInOregon.com CUSTOMER INFORMATION: CONTACT PERSON AREA CODE & PHONE NUMBER BUSINESS NAME MAILING ADDRESS TYPE OF BUSINESS BUSINESS WEBSITE ADDRESS DESCRIBE HOW THIS INFORMATION WILL BE USED BUSINESS E-MAIL ADDRESS DISCLAIMER: Fees will not be refunded if the search results in no records found. Available in (.txt (tab-delimited) format). Information Not Provided: Phone number, email address and business activity type. Tech Support not available (opening, downloading, installing etc.) SPECIAL SEARCH DATA ELEMENTS: Registry Date Status (Active/Inactive) Entity Type (Limit of 5) City or Zip Code (Limit of 5) Address (Street or PO Box) (Limit of 5) Word in Business Name (Limit of 5) Associated Name (Limit of 5) Other MEDIA TYPE CD-ROM DELIVERY OPTION: Pick-up in person E-Mail $150.00 FEE LIST CRITERIA: (Check as many Data Elements as needed and list the Criteria for each) Mail to above address E-Mail to above address Search will be performed and the results delivered within 3 business days. PAYMENT - PREPAYMENT REQUIRED. Make check payable to "Corporation Division", or you may fax this request with payment by VISA or MasterCard to 503-986-2308 Please charge my Visa/MasterCard. VISA OR MASTERCARD #: 603 - Business Registry - Request for Special Search (05/12) Signature: Expiration Date: American LegalNet, Inc. www.FormsWorkFlow.com