STATE OF SOUTH CAROLINA
SECRETARY OF STATE
APPLICATION TO RESERVE
CORPORATE NAME
TYPE OR PRINT CLEARLY WITH BLACK INK
1. Pursuant to Section 33-4-102 (a) of the 1976 South Carolina Code of Laws, as amended, the
undersigned hereby applies to the Secretary of State to reserve the following corporate name
______________________________________________________________________________________________________________________________________
for a period of one hundred twenty days from the date of filing this application.
2. Name, address and signature of the applicant
Name
______________________________________________________________________________________________________________________________________
Street
______________________________________________________________________________________________________________________________________
City State Zip Code
Date
Name Reserved
Signature
Print Name
FILING INSTRUCTIONS
1. Two copies of this form, the original and either a duplicate original or a conformed copy, must by filed. Include a self-
addressed envelope for quicker return.
2. Filing Fee (payable to the Secretary of State at the time of filing this document) - $10.00
Return to: Secretary of State
1205 Pendleton Street Suite 525
Columbia, SC 29201
NOTE
THIS RESERVATION EXPIRES 120 DAYS FROM THE DATE OF FILING.
REGISTERING YOUR CORPORATE NAME DOES NOT, IN AND OF ITSELF, PROVIDE AN EXCLUSIVE RIGHT TO USE THAT
NAME ON OR IN CONNECTION WITH ANY PRODUCT OR SERVICE. USE OF A NAME AS A TRADEMARK OR SERVICE
MARK WILL REQUIRE FURTHER CLEARANCE AND REGISTRATION AND BE AFFECTED BY PRIOR USE OF THE MARK.
FOR MORE INFORMATION, CONTACT THE TRADEMARKS DIVISION OF THE SECRETARY OF STATE'S OFFICE.
Form Revised by South Carolina
Secretary of State, September 2010
