Number
of documents to be authenticated:
Country documents will be used in:
Requestor's Name:
Name of Firm/Organization (If applicable):
Address:
Daytime telephone number: Email address:
Fees Calculation:
Apostille: Number of documents:
Certification: Number of documents:
X $10.00 per document = Net Total:
X $5.00 per document = Net Total:
Form of Payment Enclosed or Authorized:
Check drawn on U.S. bank (Checks/Money Orders must be payable to Arkansas Secretary of State.)
Money Order from a U.S. bank
Credit/Debit Card:
Visa
American Express
City:
State:
Zip Code:
Name as it appears
on Card:
Billing Address:
Card Number:
Expiration:
Payment Authorization; I au
thorize the Arkansas Secretary of State to charge my credit/debit card for the amount due for the authentication
servic
es
provided
by the
Secretary.
Cardholder’s Signature:
Date:
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:
Location for Mailed Requests and In-Person Deliveries:
Arkansas Secret
a
ry of
State
1
4
0
1 W. Capitol,
Suite 250
Little Rock, AR 72201
ARF-01 Rev. 11/18
Discover
Arkansas Secretary of State
1401 W. Capitol, Suite 250, Little Rock, AR 72201
Apostille/Certificate of Authentication Request Form
Submit this form with your documents. Please print or type.
MasterCard
CVV#:
Return Mail Address: (Address where you would like the apostille/certificate and documents sent.)
Name:
Street Address or P.O. Box:
City: State: ZIP Code:
Fee Amount Due:
Note: A 4% convenience fee
will be added to all credit/
debit card transactions.
501-682-3409 • www.sos.arkansas.gov
John Thurs
ton
