PDF document
- 1 -

Enlarge image
      Instructions for properly completing a Filing Memo 

      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 
    
   Submitters 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. 
       
   Filing 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 
    
      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



- 2 -

Enlarge image
                      State of Delaware -  Division of Corporations 
                                                  DOCUMENT FILING 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  SUBMITTER’S INFORMATION                                                                                                  DO NOT WRITE IN THIS SPACE 
                                                                                                                                                                                EACH REQUEST MUST BE  
                                                                                                                                                                                SUBMITTED AS A SEPARATE          
      Company/Firm or Company/Firm or                                                                                                                                           ITEM WITH THIS FILING  
      Individual’sIndividual’s Name  Name                                                                                                                                       SHEET AS THE FIRST PAGE          
      Return Address Return Address                                                                                                                                             OF EACH SUBMISSION.
  
      City – State - Zip                                                                                                                               
  
      Attention:  Attention:                                                                                                                           
  
      Phone#  Phone#                                                          Fax#    Fax#                                                             
  
      E-mail address E-mail address                                                                                                                    
      AccountAccount Number       Number                                                                                                               
                                                 
      DOCUMENT FILING REQUEST INFORMATION 
      Name of Company/Entity                                                                                                                                                                                  
       
      File Number                                                                               Reservation Number                                                                                            
       
      Type of Document                                                                                                                                                                                         
       
      Check if document is: 
      Changing Name                                                          Changing Registered Agent                                                                             Changing Stock              
   
      OTHER DOCUMENT FILING INFORMATION                                                           METHOD OF RETURN 
                                                                                                  _____ Messenger/Pick up                                                                Select Express Type
                                       # of Certified Copies returned                             _____                                              Express Service Delivery  
                                                                                                   Acct#___________________________________ 
      Other requests                                                                              _____                                              Regular Mail 
                                                                                                   
      Check #                                      Total $ enclosed                               _____                                              Other __________________________________ 
                                                                                                        Fax or e-mail is not available.

      CREDIT CARD INFORMATION                                              Card Type              COMMENTS/FILING INSTRUCTIONS 
      (Visa, MasterCard, American Express&   Discover Card Only) 
       
                              -                  -                       -   
       
      Expiration Date -                            /                          Sec. Code_________ 

      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. .   






PDF file checksum: 2809432658

(Plugin #1/8.13/12.0)