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Contact Information:
Name
Mailing Address
City State Zip Code
Email Address Phone Number
INSTRUCTIONS (Refer to section 181.1503, Wis. Stats., for document content)
Please use BLACK ink. Submit one original to State of WI-Dept. of Financial Institutions, Box 93348,
Milwaukee WI, 53293-0348, together with a check for the filing fee of the amount calculated in the Supplement
or $100.00 (if not required to complete the Supplement), payable to the Department of Financial Institutions. (If
sent by express or priority U.S. mail, please mail to State of WI-Dept. of Financial Institutions, Division of
Corporate and Consumer Services, 4822 Madison Yards Way, 4th Fl., North Tower, Madison WI, 53705.) If
requesting optional expedited service, please check the expedited service box in the upper-right corner of the
first page and include an additional $25.00. Filing fees are non-refundable. This document can be made
available in alternate formats upon request to qualifying individuals with disabilities. Upon filing, the
information in this document becomes public and might be used for purposes other than those for which it was
originally furnished. If you have any questions, please contact the Division of Corporate & Consumer Services
at 608-261-7577 (hearing-impaired may call 711 for TTY) or by email atDFICorporations@dfi.wisconsin.gov .
NOTE: Every application must be accompanied by a current CERTIFICATE OF STATUS
(sometimes called “certificate of existence” or “certificate of good standing”) issued by the Secretary of State
(or other official having custody of corporate records) in the state or country under whose laws the corporation
is incorporated, attesting to the existence and status of the corporation. The certificate must be issued not more
than 60 days prior to the date the document is received in this office, in condition for filing. A certified copy of
the charter documents is not an acceptable substitute.
Item 1. Enter the name of the foreign corporation that is registering with the Department.
Item 2. The name under which the corporation is registered in this state must be distinguishable on the records
of the Department from other entities that are registered with the Department and from any name that has been
reserved or registered with the Department. You can preliminarily check the availability of an entity name using
the Department’s corporate records database, which is publicly available through the Department’s website.
If the name of the corporation is not distinguishable on the records of the department as provided in s.
181.1506(2), Wis. Stats., complete the separate form 21B and enter the fictitious name under which the entity
will do business in this state. The name must contain the word “corporation,” “incorporated,” “company,” or
“limited” or the abbreviation “corp.”, “inc.”, “co.”, or ltd.”, or a variation of these words or abbreviations of like
import in another language, or that differs only with respect to capitalization of letters or punctuation.
Items 3 & 4. Enter the name of the jurisdiction (either a state other than Wisconsin or a foreign country) under
whose laws the foreign corporation is incorporated, as well as the date of its incorporation.
Item 5. Indicate whether the corporation has perpetual existence or a defined period of duration. If it has a
defined period of duration, state its period of duration.
Form Corp121 (Revised February 2023) Use of this form is mandatory. Page 3 of 5
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