Instructions for properly completing a Certification Memo
Submitter’s Information
Mark the appropriate priority box. (additional Expedited Cost)
Fees: Priority 1 (One hr) - $1000.00
Priority 2 (Two hr) - $ 500.00
Priority 3 (Same Day) - Varies – Please contact our Office
Priority 4 (24 hour) - Varies – Please contact our Office
Submitter’s Information
1. Completely fill out your individual or business/firm name and complete address. The attention line needs to
be completed if a business or firm name is listed.
2. The account number is only to be completed by entities that have an existing Depository account with
the Division of Corporations. Please ignore this field if you do not have a Depository account.
Certification Request Information
Complete the name of the entity and the entity File number. If you do not have the file number, you
may leave it blank.
Method of Return Information
All documents are returned Regular Mail or you can provide a Fed-X or UPS account number for express
mail. Please mark the appropriate method of return.
Credit Card Information
All credit card information must be completed. If the credit card information is not the same as it is listed
with the submitter’s information, then please specify the correct information in the comments/filings
instruction area on the bottom right hand side of the memo. You must also include your 3-4 digit security
code on the back of the card.
Please contact our office at 302-739-3073 with any questions or for verification of fees.
Return forms and memos to:
Delaware Division of Corporations
401 Federal Street - Suite 4
Dover, DE 19901
State of Delaware - Division of Corporations
CERTIFICATION SHEET - Fax# 302-739-3812
Priority 1 Priority 2 Priority 3 Priority 4 Priority 7
(One Hr) (Two Hr) (Same Day) (24 Hour) (Reg. Work)
SUBMITTER’S INFORMATION
Company/Firm or
Individual’s Name
Return Address
City - State - Zip
Attention:
Phone# Fax#
E-mail address
Account Number
DO NOT WRITE IN THIS SPACE
CERTIFICATION REQUEST INFORMATION
Name of Company/Entity
File Number
Type of Certificate Requested
Certified Copy of All Charter Documents
Certified Copy of Charter Documents, Restated Forward
Certified Copy Filed on
Short Form Good Standing (check if additional language req.)
Tax reports filed
Taxes paid to date
No taxes assessed
Long Form Good Standing (check if additional language req.)
Tax reports filed
Taxes paid to date
No taxes assessed
Certificate in RE:
Apostille - Country
Other
Check # Total $ Enclosed
CREDIT CARD INFORMATION
(Visa, MasterCard, American Express or Discover Card Only)
CC# - - -
Expiration Date -
Security Code
METHOD OF RETURN
_____ Messenger/Pick up
_____ Express Mail
Acct#
_____ Regular Mail
_____ Other
__________ __________ __________ __________
/
____________________
(Typ
e
o
f Cert.)
COMMENTS/FILING INSTRUCTIONS
INSTRUCTIONS
1. Visit corp.delaware.gov/cvrmemo.shtml
for complete instructions
on how to properly complete this memo.
2. Fully shade in the required Priority Square using a dark pencil
or marker, staying within the square.
Visa
Select Express Service
Fax or E-mail is not available
Delaware Division of Corporations, 401 Federal Street, Ste. 4, Dover, De 19901