PENNSYLVANIA DEPARTMENT OF STATE
BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS
This form MUST be completed and submitted with EACH expedited request.
EXPEDITED REQUESTS MUST BE SUBMITTED IN PERSON.
Entity Name:
Entity Number:
Requestor’s Name: _____
__________________________________
Requestor’s Address: _____________________________________
_______________________________________________________
Contact Person:__________________________________________
Phone Number:__________________________________________
Return Document Via: (CHECK ONLY ONE)
COUNTER PICKUP
EMAIL - Completed filings will be emailed
to the email address supplied below.
__________________________________
Select the Level of Expedited Service:
EXPEDITED SERVICE FEES ARE IN ADDITION TO FILING FEES. Expedited Fee(s):
SAME-DAY SERVICE (must be received before 10:00 a.m.)
$100.00
THREE-HOUR SERVICE (must be received before 2:00 p.m.
)
$300.00
ONE-HOUR SERVICE (must be received before 4:00 p.m.) $1,000.00
Payment Method:
Deposit Account number
______________________________
Check
By checking this box, I ve
rify that I have read and understand the policies and procedures for Expedited
Services published in the Pennsylvania Bulletin. To the best of my knowledge, the attached document is
acceptable for filing as presented to the Bureau. I understand that if this document is not accepted for filing,
the expedited service fee and the filing fee(s) are nonrefundable.
*15315*
15315
Expedited Service Request
DSCB:15-153(a)(15)
(rev.
7/1/2015)
