State of North Carolina
Department of the Secretary of State
APPLICATION TO RESERVE A BUSINESS ENTITY NAME
Pursuant to §55D-23 of the General Statutes of North Carolina, the undersigned hereby applies to the Secretary of State to reserve the
following business entity name:
1. The business entity name to be reserved is:
_____________________________________________________________________________________________________
2. The name of the applicant is: ______________________________________________________________________________
3. The address of the applicant is:
Street Address __________________________________________________________________________________________
City, State, Zip Code _____________________________________________________________________________________
4. The above entity name is to be reserved for a nonrenewable period of 120 days from the date of the filing of this application.
This the _________ day of ________________ , 20_____.
_____________________________________________
Entity Name
_____________________________________________
Signature
_____________________________________________
Type or Print Name and Title
NOTES:
1. Filing fee is $30. This document must be filed with the Secretary of State.
CORPORATIONS DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622
(Revised October 2002) (Form BE-03)
