Means of payment are: cash, check, credit card or money order made payable to the “State of Utah.” If faxing you
must include, on a cover sheet, the number of a Visa, MasterCard, or American Express with the date of expiration.
Business Information
Requested Business Name: The name of the entity that you want to use.
Business Purpose: The general purpose of the business. You may use a specific code (NAICS Code) for
this. The codes can be searched at: http://www.census.gov/epcd/www/naics.html
Business Address: The address of where the principal place of business is located.
Registered Agent: The individual or entity designated for service of process for the entity.
Registered Address: The address of the Registered Agent; it must be a Utah Street Address. A PO Box
may be entered on the second line of the address block. All correspondence from the Division will go to this
address.
Applicant/Owner Information
Name: The
individual or business entity that will own the DBA. If the applicant/owner is a business it must be
registered in Utah and the Entity Number should be the Utah Entity Number issued by the Division of Corporations.
Entity Number: The entity number of the registered business issued by the Division of Corporations.
Address: The address of the individual or business entity that will own the DBA.
City: The city where the individual or business entity is located.
State: The state where the address for the individual or business entity is located.
Zip: The zip code where the individual or business entity is located.
Signature Line: An authorized party of the entity must sign the form; the signer’s title and the date of the
signature must also be included.
The process for the Applicant/Owner/Partner is repeated if you have two Applicants/Owners/Partners.
If you have more than two Applicants/Owners/Partners you will need to fill out another DBA Application.
State of Utah
DEPARTMENT OF COMMERCE
Division of Corporations & Commercial Code
Business Name Registration / DBA Application Instructions
Under GRAMA {63G-2-201
}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, you
may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity.
www.corporations.utah.gov
Mailing/Faxing Information:
www.corporations.utah.gov/contactus.html
