APPOINTMENT OF THE SECRETARY OF STATE
AS AGENT OF SERVICE
THE STATE OF ____________________ }
[ KNOW ALL MEN BY THESE PRESENTS
COUNTY OF _______________________}
That________________________________________________________________, a
telephone solicitation seller in the state of ____________________, does hereby irrevocably
designate, constitute and appoint the Secretary of State of the State of Texas and any successors
in office, the authorized agent and attorney-in-fact of the above-named seller for the purpose of
accepting service for it and being served for it with citation in any noncriminal suit, action, or
proceeding against said seller or the seller's successor, executor, or administrator that may arise
under Tex. Bus. & Com. Code, Section 302.001 et seq.
_________________________________ _____________________________________
(Signature & Title) (Signature & Title)
_________________________________ _____________________________________
(Typed or Printed Name) (Typed or Printed Name)
_________________________________ ____________________________________
(Signature & Title) (Signature & Title)
_________________________________ _____________________________________
(Typed or Printed Name) (Typed or Printed Name)
State of ______________________
County of ____________________
Sworn to and subscribed before me on the _______ day of ______________________, _______.
_____________________________________
Notary Public Signature
(seal)
_____________________________________
(Printed Name)
My commission expires __________________.
Form #3406
