Application for Reservation of
a Corporate Name
Delaware Division of Corporations
401 Federal Street – Suite 4
Dover, DE 19901
Phone: 302-739-3073
Fax: 302-739-3812
Dear Sir or Madam:
Enclosed please find an application for reservation of a Corporate Name to be
filed in accordance with the Corporate Law of the State Of Delaware.
The fee to file the application is $75.00 to be accompanied with the application.
Please make your check payable to the “Delaware Secretary of State”.
Thank you for choosing Delaware as your corporate home. Should you require
further assistance in this or any other matter, please don’t hesitate to call us at (302) 739-
3073.
Sincerely,
Department of State
Division of Corporations
Encl.
Rev 07/06
____________________________________________________________________
STATE OF DELAWARE
CORPORATE NAME RESERVATION
APPLICATION PURSUANT TO
TITLE 8, SECTION 102
OF THE DELAWARE CODE
TO: THE SECRETARY OF STATE
OF THE STATE OF DELAWARE
PLEASE RESERVE, IF AVAILABLE, THE FOLLOWING CORPORATE NAME:
(list nam
e to be reserved here)
FOR THE EXCLUSIVE PERIOD OF 120 DAYS PURSUANT TO THE PROVISIONS OF
TITLE 8, SECTION 102 OF THE DELAWARE CODE, THE UNDERSIGNED BEING THE
PERSON INTENDING TO FORM A CORPORATION AND ADOPT THE ABOVE
RESERVED NAME, HEREBY EXECUTES THIS APPLICATION THIS
DAY OF _______________________, ________A.D. _____________________
NAME AND ADDRESS OF APPLICANT: (if reserving for
a company or firm, please list the
firm or company name and have an attention person added to the bottom after the address)
BY:_________________________________
Signature of Applicant
Name:_________
________________________
Print or Type Name