State of Arizona Office of the Secretary of State
Trade Name Registration Application
SEND BY MAIL TO:
Secretary of State Michele Reagan, Atten: Trade Name/Trademark Division
1700 W. Washington Street, FL. 7, Phoenix, AZ 85007-2808
OR return this application in person:
PHOENIX - State Capitol Executive Tower,
1700 W. Washington Street, 1st Fl., Room 103
TUCSON - Arizona State Complex,
400 W. Congress, 1st Fl., Suite 141
Office Hours: Monday through Friday, 8 a.m. to 5 p.m., except state holidays.
PLEASE NOTE: The registration of a Trade Name is not legally required in Arizona,
but is an accepted business practice. The registration is a public record and does not
constitute exclusive rights to the holder of the Trade Name.
DO NOT WRITE IN THIS SPACE
FOR OFFICE USE ONLY
SOSBSTN REV. 1/5/2015
APPLICANT INSTRUCTIONS
Be Accurate: Complete all applicable fields on this form. Write legibly; or
fill out this application online at www.azsos.gov and print it.
Filing Fee and Payment: $10; expedited service, include an additional
$25. Checks or money orders shall be made payable to the Secretary of
State. Credit cards are not accepted.
Questions? Call (602) 542-6187; in-state/toll-free (800) 458-5842.
Website: All forms are available on the Secretary of State’s Website,
www.azsos.gov.
1. Name, title or designation to be registered
SPACE BELOW FOR OFFICE USE ONLY - VALIDATION AREA
Trade Name (Names with a corporate ending are unacceptable. Examples: Inc., LLC. or Ltd.)
The date which the name above was first used by the applicant
in Arizona. This date must be today or prior to today’s date.
Month
Day
Year
2. Entity Type and Owner Name
What type of person or entity functions as the owner of this trade name? Enter the entity or person(s) name. CHOOSE ONLY ONE.
A. SOLE PROPRIETORSHIP (one person)
B. ASSOCIATION
C. ORGANIZATION
Applicant First and Last Name
Association Name
Organization Name
D. PARTNERSHIP [List name(s)]
Either provide the partnership name(s) OR multiple individuals by the Applicants’ First and Last Name
E. CORPORATION *
F. LIMITED LIABILITY COMPANY (LLC) *
Corporation Name
Limited Liability Company Name
*Corporation/LLC: If checked the applicant must be on the Arizona Corporation Commissions website as a member/officer. The application will be returned if not incorporated.
G. FOREIGN CORPORATION Licensed to do business in Arizona
H. OTHER (If other, please indicate type. Examples: firm, society, foundation, federation)
Foreign Corporation Name
Other Name
3. Nature of Business
General nature of business conducted
4. Contact Information Addresses must be complete as they are used to mail certificates and renewal notices.
Mailing Address
Apt., Space, Suite, or Floor #
City
State
Zip Code
Business Phone Number
( )
5. Applicant’s Signature ~ If two applicants are listed in Section 2D, both must sign.
1
st
Signer’s Printed Name
2
nd
Signer’s Printed Name (if applicable)
1
st
Signer’s Signature
Date
2
nd
Signer’s Signature
Date
State of Arizona )
County of ___________________ )
On this ______ day of ________________________, 20 ____
__________________________________________________
(Name of Person Appearing Before the Notary)
personally appeared before me and acknowledged that he/she
signed this document for it’s stated purpose.
___________________________
(Notary Public)
State of Arizona )
County of ___________________ )
On this ______ day of ________________________, 20 ____
__________________________________________________
(Name of Person Appearing Before the Notary)
personally appeared before me and acknowledged that he/she
signed this document for it’s stated purpose.
___________________________
(Notary Public)
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