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APPLICATION FOR CERTIFICATE West Virginia Secretary of State
OF AUTHORITY Business & Licensing Division
Form CF-1 Tel: (304)558-8000
Rev. 6/5/2019 Fax: (304)558-8381
Website: www.wvsos.gov

FILE ONE ORIGINAL
(Two if you want a filed stamped
copy returned to you.)
FILING FEE:$100 (profit)
$50 (non-profit)
Control #
* Fee Waived for Veteran-owned corporation

*** The undersigned, having authority to transact business on behalf of a foreign (out-of-state) registered entity, agrees to ***
comply with the requirements of WVCode §31D-15 to apply for Certificate of Authority.
1. Home State Information:
a. The name of the corporation as it
is registered in its home state is:
b. State of Date of Incorporation: Duration (no. yrs. or perpetual):

c. NAIC# (if an insurance company):

CHECK HERE to indicate you have obtained and submitted with this application a CERTIFICATE OF EXISTENCE (GOOD
STANDING), dated during the current tax year, from your home state of original incorporation as required to process your
application. The certificate may be obtained by contacting the Secretary of State's Office in the home state of original incorporation.

2. Principal Office Information:

a. Principal offic eaddress of the No. & Street:
corporation is:
City: State: Zip Code:

b. Mailing address, if different from
Street/PO Box:
above address:

City: State: Zip Code:

3. West Virginia Office Information:
a. Corporate name to be used in WV: Home state name as listed on line 1a. above, if available. (If name is not
[The name must contain one of the required available, check DBA Name box below and follow special instructions under Section
terms such as "Corporation," "Corp." or 3a. attached to this application.)
"Inc." See instructions for complete list of
acceptable terms and requirements for use DBA Name:
of Trade Name.]
(See special instructions in Section 3a. regarding the Letter of Resolution
approving use of a "forced DBA Name" attached to this application. View a sample
Letter of Resolution.)
b. Designated (physical) office
No. & Street:
address in West Virginia, if any:

City: State: Zip Code:

c. Located in the County of: County:

d. Mailing address in West Virginia,
Street/PO Box:
if different from above:

City: State: Zip Code:

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APPLICATION FOR CERTIFICATE OF AUTHORITY Page 2
4. Agent for Service of Process: Name:
Properly designated person to whom notice
of legal process may be sent, if any. No. & Street:
City: State: Zip Code:

5. E-mail address where business correspondence may be received:
6. Website address of the business, if any (ex: yourdomainname.com):
7. Do you own or operate more than one Yes * Answer a. and b. below. No Decline to answer
business in West Virginia?
If "Yes"... a. How many businesses? b. Located in how many West Virginia counties?

8. a. Proposed purpose(s) for transaction of business in West Virginia is(are): *NOTE - "Professional" business organizations must
attach to this Certificate of Authority application the Verification of Eligibility (Form VOE) authorized by your professional state licensing board
(see attached instructions and CHECK BOX below). [In the space below, describe the type(s) of business activity which will be conducted, for
example, “agricultural production of grain and poultry,” “construction of residential and commercial buildings." Purpose may conclude with
words “…including the transaction of any or all lawful business for which corporations may be incorporated in West Virginia.”]

Professional business organizations: CHECK BOX indicating you have attached the state licensing board Verification of Eligibility
(Form VOE) to this Certificate of Authority application if your profession meets the requirements as defined by Chapter 30 of the WV
Code. See Section 8 of the attached instructions for a list of professions. Your application will be rejected if the VOE signed by the
board is not attached.
b. Will the above purpose include any business activity conducted as a consumer litigation financier pursuant to WV Code §46A-6N?
Yes [By checking "Yes," the applicant affirms the above purpose includes the required statement that the organization shall be
designated as a litigation financier pursuant to WV Code §46A-6N.You are also affirming that you have included with this
application an original completed copy of the required Application for Registration as a Litigation Financier (Form LF-1) with the
associated requisite filing fee.]
No [Proceed to Section 8c.]

c. Will the incorporation elect to be organized for purposes as a “Benefit Corporation” per West Virginia Code §31F? ONLY applicable to
"FOR PROFIT" corporations; "NON-PROFIT" corporations CANNOT elect this status.
Yes [If "Yes," the corporation must be formed FOR PROFIT and the purpose(s) indicated in Section 8a. above must include a
"general public benefit" as set forth in §31F-3-301(a) of the West Virginia Code. Per §31F-1-102(c), “general public benefit”
means “a material positive impact on society and the environment taken as a whole, as measured by a third-party standard,
from the business and operations of a benefit corporation."].
No [Proceed to Section 9.]
9. Is the business a Scrap Metal Dealer?
Yes [If "Yes," you must complete the Scrap Metal Dealer Registration Form (Form SMD-1) and proceed to Section 10.]
No [Proceed to Section 10.]

10. Corporate Status Information:
a. Corporation is organized as (check one): For Profit Non-Profit
b. Officers and Directors: (add additional pages if necessary; please list all officers)
Officer Title Officer Name No. & Street Address City State Zip Code

Continued on next page.

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APPLICATION FOR CERTIFICATE OF AUTHORITY Page 3

b. Officers and Directors (continued): (add additional pages if necessary; please list all officers)
Officer Title Officer Name No. & Street Address City State Zip Code

11. Is the organization a "veteran-owned" organization?
Effective JULY 1, 2015, to meet the requirements for a “veteran-owned” organization, the entity filing the registration must
meet the following criteria per West Virginia Code §59-1-2a:

1. A “veteran” must be honorably discharged or under honorable conditions, and
2. A “veteran-owned business” means a business that meets one of the following criteria:
o Is at least fifty-one percent (51%) unconditionally owned by one or more veterans; or
o In the case of a publicly owned business, at least fifty-one percent (51%) of the stock is unconditionally owned by one or
more veterans.

Yes (If "Yes," attach Form DD214) CHECK BOX indicating you have attached Veteran Affairs Form DD214
No You may obtain a copy National Personnel Records Center
of your Veterans Affairs Military Personnel Records
Form DD214 by 1 Archives Drive
contacting: St. Louis, MO 63138
Toll free: 1-86-NARA-NARA or 1-866-272-6272
Phone: 314-801-0800
www.archives.gov/veterans/military-service-records
Per WV Code 59-1-2(j) effective July 1, 2015, the registration fee is waived for entities that meet the requirements as a "veteran-owned"
organization. See attached instructions to determine if the organization qualifies for this waiver. In addition, a "veteran-owned" entity will have
four (4) consecutive years of Annual Report fees waived AFTER the organization's initial formation [see WV Code 59-1-2a(m)].

12. The number of acres of land it holds or expects to hold in West Virginia is:
13. Contact and Signature Information* (See below Important Legal Notice Regarding Signature):

a. Contact person to reach in case there is a problem with filing: Phone:

b. Print or type name of signer: Title/Capacity of signer:

c. Signature: Date:

*Important Legal Notice Regarding Signature: Per West Virginia Code §31D-1-129. Penalty for signing false document. Any person
who signs a document he or she knows is false in any material respect and knows that the document is to be delivered to the secretary of state for
filing is guilty of a misdemeanor and, upon conviction thereof, shall be fined not more than one thousand dollars or confined in the county or
regional jail not more than one year, or both.

Important Note: This form is a public document. Please do NOT provide any personal identifiable information on this form such as social
security number, bank account numbers, credit card numbers, tax identification or driver's license numbers.

Reset Form Print Form

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INSTRUCTIONS FOR FILING WEST VIRGINIA APPLICATION FOR CERTIFICATE OF AUTHORITY

Check for availability of the corporate name in West Virginia. Preliminary information is available by phone at 304-558-8000. To reserve your name, file an application
for name reservation with a $15 fee. If approved, the name will be held for 120 days. If an insurance company, list your NAIC number, if you have one. Insurance
companies are subject to and must adhere to the naming provisions of West Virginia Code §33-1-12.

***IMPORTANT *** Obtain a “ Certificate of Good Standing ”or“Certificate of Existence ” (also known in some states as a “Certificate of Status," or “Certificate
of Fact), from your home state of original incorporation dated during the current tax year. You may contact the home state of original incorporation's Secretary of
State Office to obtain a current copy of the Certificate of Good Standing (Existence).

Pursuant to West Virginia Code §33-3-3 the Secretary of State shall not issue a certificate of incorporation to any insurance company until the West Virginia Insurance
Commissioner has examined the charter of the insurance company and approved same in writing. If the application is for a currently licensed insurance company,
please submit a copy of the Certificate of Authority issued by the West Virginia Insurance Commissioner for your current tax year. If the application is from an
insurance company with a pending license review before the West Virginia Insurance Commissioner, please submit a copy of the written approval of the charter from
the Office of the Insurance Commissioner. Submitting a copy of the Certificate of Authority issued by the West Virginia Insurance Commissioner or copy of the
written approval of the charter, whichever is applicable, at the time of filing will avoid denial of the application by the Secretary of State.

Complete one original application according to the instructions below. If you would like a “filed date-stamped” copy returned to you, then submit two original
applications. Incomplete applications will be returned to you for correction.

Mail or deliver to the Secretary of State the following as a packet:
� Certificate of Existence/Good Standing, dated during the current tax year, from the original State of Incorporation (the certificate is normally issued by the
home state of formation's Secretary of State,
� Original application(s) for Certificate of Authority, signed by an officer of the corporation,
� A letter of resolution of your board of directors adopting a forced DBA Name if your home state name isn't available in West Virginia,
� Insurance companies include a copy of the Certificate of Authority issued by the WV Insurance Commissioner for your current tax year or a copy of the
written approval of the charter from the Offices of the West Virginia Insurance Commissioner,
� Scrap Metal Dealersmust also include a completed Scrap Metal Dealer Registration Form (Form SMD-1)[per revised West Virginia Business Code
§61-3-49-(b)(4)] and submit with the application.

Completing the Application

Section 1. a. The name entered here must match the name on your good standing certificate.

b. Even if your corporation is not perpetual in your home state, remember that your responsibilities for tax reporting in
West Virginia will not end until you file a certificate of withdrawal.

c. If an insurance company, list your NAIC number, if you have one.
CHECK THE BOX to indicate you have obtained and submitted with this application a CERTIFICATE OF EXISTENCE (GOOD
STANDING), dated during the current tax year, from your home state of original organization as required to process your
application. The certificate may be obtained by contacting the Secretary of State's Office in the home state of original organization.

Section 2. a. The principal office address, whether it is in West Virginia or out-of-state.

b. Enter the principal mailing address, if different from principal office address.

Section 3. a. PLEASE READ CAREFULLY! More applications are rejected due to invalid name selection than any other reason.

Is your name available? The name of a corporation shall not be the same as, and shall be distinguishable from any other name which has been reserved or filed. The
“distinguishable” standard is defined as meaning (a) at least a one word difference when the words are common terms and the company is or might appear to be in a
similar business; or (b) at least a word order difference between names when the different word is a proper name or an unusual term, or when the company is clearly in
a different type of business from the existing company.
� If your home state name is available, but does not include a corporate suffix such as “Inc.” or“Corp.”…. enter your corporate
name on the second line and add a corporate suffix.
� If your home state name is not available…attach a resolution of the board of directors adopting an available fictitiousname for use to
transact business in West Virginia and enter the name on 3.a. “DBA” (doing business as name).
Does your name misrepresent the purpose of your corporation? The name of a corporation may not contain any word or phrase which indicates or
implies it is organized for any purpose other than one or more of the purposes in its articles of incorporation.
� Banking and Insurance: Words implying the business of banking or insurance may only be used if the corporation is authorized under
the laws of this state to engage in those businesses.

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          � Engineering:Words such as “engineer” or “engineering” may be used only if the purpose of the corporation is to practice professional 
           engineering and one or more of the officers are registered in West Virginia as a professional engineer. You must enclose with the 
           Secretary of State's Application for Certificate of Authority, (Form CF-1), a copy of your latest Certificate of Authorization 
           (COA) issued by the following state licensing   board upon your most recent COA application or renewal (Without this proof of 
           authorization, your application will be rejected  and returned to you.):
             
           West Virginia State Board of Registration for Professional Engineers 
           300 Capitol Street 
           Charleston, WV 25301 
           304-558-3554 
              www.wvpebd.org 
        
      �  Professional Corporation: If the home state name includes the abbreviation “P.C.” in the corporate name (indicating a “Professional 
           Corporation”) the words “Professional Corporation” must be spelled out in full to be eligible to file in State of West Virginia. 
        
                    b.  Enter thedesignated (physical) office addressin  West Virginia, if any. 
        
                    c.  Enter the name of the West Virginia county in which the designated (physical) office is located. 
        
                    d.  Enter the mailing address of the registered office in West Virginia, if any.
Section 4.        Provide the name and address of a person or business (agent) to whom a summons or complaint may be mailed, if any.  The agent need not have a 
West Virginia address.  You may change your agent by filing with the Secretary of State an application to appoint or change address, agent or officer [Form AAO] (fee 
$15). 
  
Section 5.          List an e-mail address (yourname@domainname.com) where you can receive important e-mail notifications (e.g., Annual Report notices). 
  
Section 6.          List the website address (domainname.com) of the business, if any. DO NOT list a physical mailing address. 
  
Section 7.          Indicate whether or not you own or operate more than one business in West Virginia. If “Yes"... 
                    a.  List the total number of businesses in West Virginia in the space provided. 
                    b.  List the total number of counties in West Virginia in which the businesses conduct operations. 
  
Section 8.          a.  It is required you describe the purpose [i.e., principal activity to be conducted by the business] of the corporation clearly to ensure you receive all the 
necessary information about registering with the required state agencies. Attach an additional page if necessary.  Only the following professions listed below under 
the specified articles of Chapter 30of West Virginia Code may register as a "professional" business organization. 
                    Attorneys-at-law          [Article 2]                   Physicians & Podiatrists                [Article 3] 
                    Dentists                  [Article 4]                   Optometrists                            [Article 8] 
                    Accountants               [Article 9]                   Veterinarians                           [Article 10] 
                    Architects                [Article 12]                  Engineers                               [Article 13] 
                    Land Surveyors            [Article 13a]                 Osteopathic Physicians & Surgeons       [Article 14] 
                    Chiropractors             [Article 16]                  Psychologists                           [Article 21] 
                    Social Workers            [Article 30]                  Acupuncturists                          [Article 36]                  
  
***Important***         Professional business organizations: CHECK BOX indicating you have attached Verification of Eligibility (Form VOE) to this application if 
your profession meets the requirements as defined by Chapter 30 of the WV Code. The Secretary of State cannot complete your filing until verification is received 
from the appropriate state licensing board. Your application will be rejected if the VOE is not signed by the board and attached. 
  
                    b.  If "No," proceed to Section 8c. If "Yes," the above purpose includes any business activity conducted as a consumer litigation financier, pursuant to 
WV Code §46A-6N, the organization must register as a litigation financier by completing and submitting to Secretary of State an original copy of the Application for 
Registration as a Litigation Financier (Form LF-1) and pay the associated requisite filing fee. If this applies to your organization, check the "Yes" box to include in 
your purpose the required statement that the organization shall be designated as a litigation financier.    
  
                    c.  If “No,” proceed to Section 9. If “Yes,” and the FOR PROFIT incorporation elects to be organized for purposes as a “Benefit Corporation,” per 
West Virginia Code §31F-3-301 (NON-PROFIT corporations CANNOT elect this status), the purpose listed in Section 8a. above must clearly state as one of its 
purposes the purpose of creating a “general public benefit.” You must indicate as one of its purposes stated in Section 8a. above the purpose of creating a “general 
public benefit” as set forth in §31F-3-301(a) of the West Virginia Code. A “general public benefit” means “a material positive impact on society and the environment 
taken as a whole, as measured by a third-party standard, from the business and operations of a benefit corporation,” [see West Virginia Code §31F-1-102(c)]. This 
purpose is in addition to its principal business purpose stated under §31D-3-302 of the West Virginia Code. It may also identify one or more “specific public benefits” 
that it is the purpose of the corporation to create. Per West Virginia Code §31F-1-102(e) “specific public benefit” means “a benefit that serves one or more public 
welfare, religious, charitable, scientific, literary or educational purposes, or other purposes or benefit beyond the strict interest of the shareholders of the benefit 
corporation, including: 
  (1)   Providing low-income or under served individuals or communities with beneficial products or services; 
  (2)   Promoting economic opportunity for individuals or communities beyond the creation of jobs in the normal course of business; 
  (3)   Preserving or improving the environment; 
  (4)   Improving human health; 
  (5)   Promoting the arts, sciences or advancement of knowledge; 
  (6)   Increasing the flow of capital to entities with a public benefit purpose; and 
  (7)  Conferring any other particular benefit on society or the environment.”

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Section 9. If the business activities include “Scrap Metal Dealer,” check “Yes” and complete the Scrap Metal Dealer Registration Form (Form SMD-1) [per
revised West Virginia Business Code §61-3-49-(b)(4)] and submit with your application. Proceed to Section 10. If “No,” proceed to Section 10.

Section 10. a. Check whether the corporation is formed for profit or non-profit purposes.

b. List the officer titles (i.e., President, Vice-President, Secretary, Treasurer, Director, etc.), officer names and addresses (street number with
street name, city, state and zip code) for each of the officers/directors of the corporation. The address information may be either the officer/director's personal
address or the corporate business address. Attach additional pages, if necessary.

Section 11. Check the appropriate box indicating whether or not the corporation is "veteran-owned." Effective JULY 1, 2015, the following criteria must be met
in order to qualify as a "veteran-owned" entity: (1) veteran must be "honorably discharged or under honorable conditions;" and (2) a privately-owned entity must be at
least fifty-one per cent (51%) unconditionally owned by one or more veterans; or (3) if a publicly-owned entity, at least fifty-one per cent (51%) of the stock must be
unconditionally owned by one or more veterans [see WV Code 59-1-2a(12)-(13)(A)(B)].If "Yes," you must provide proof of veteran status by including with this
application a copy of your Veteran Affairs Form DD214.

Section 12. Enter the number of acres the company desires to hold in West Virginia. If your company holds more than 10,000 acres of land, you must submit a fee
of 5¢ for each acre over 10,000.

Section 13. a. Listing the name of a contact person is optional; however, listing one may speed up the filing process and avoid a possible rejection of the filing if
there appears to be a problem with the filing.

b. Print the name of the person signing and list the title/capacity

c. AN INDIVIDUAL (OFFICER/DIRECTOR) WITH SIGNATURE AUTHORITY MUST SIGN AND DATE THE FORM. The application
will be returned to you as incomplete if received by our office without a signature.

ANNUAL REPORT NOTICE:
West Virginia Code 59-1-2a.requires every corporation (both for profit and non-profit) to file an annual report and pay the annual report filing fee
between January 1 and July 1 of each year following the calendar year in which the business was registered with the Office of the Secretary of State. The $25
annual report fee is waived for Veteran-owned entities for the following four (4) years after initial formation in West Virginia [see West Virginia Code
59-1-2a(m) ].Failure to file may result in revocation of the organization's legal authority to transact business in the state. Notification of the filing
requirement will be sent, but the company is responsible for filing the annual report as required by West Virginia Code. You may file the annual report
online athttps://onestop.wv.gov. You mustregister a User Account Login ID and Passwordto create a personal “Filing Cabinet” to file the annual report.
West Virginia Code §31F-5-501 requires every “benefit corporation,” as described in Section 8b. above, to prepare an annual benefit report
(separate and unrelated to the Secretary of State Annual Report referenced above) made available annually to each shareholder of the benefit corporation.
See West Virginia Code §31F-5-501 for further information regarding the “Annual Benefit Report.”

FILING THE APPLICATION - ONE ORIGINAL REQUIRED - AND PAYING THE FEE
Send an additional original if you want a filed date-stamped copy returned to you at no additional cost.
The filing fee will consist of paying a registration fee and excess acreage fee, if applicable.
If requesting a certified copy, an additional fee of $15 per certified copy requested is required.

For Profit Corporations - $100
Non-Profit Corporations - $50
* Veteran-owned entity registrationFEE WAIVED -$0
Registration fee* _______________ [Registration fee is waived effective July 1, 2015 per WV Code 59-1-2(j); Be
sure to attach the veteran proof of status Veteran Affairs Form DD214 .]
Expedite Fee is additional if requesting expedite service. See Customer Order Request
Excess Acreage fee: +_______________ form for more information.

$15 per certified copy: +_______________

Total fee: =_______________

**** Make your checks payable to West Virginia Secretary of State. ****

TEXT ALERTS: Stay up-to-date regarding filing deadlines and changes to business, charity, notary, private investigation, and security guard laws. To sign up, visit
the Secretary of State online at www.wvsos.gov and select Text Alerts. Next, under the heading, “Choose SMS Subscription,” click the down arrow and select
“Business and Licensing.” Then enter your ten-digit mobile phone number and your cellular carrier. Click Subscribe. This will allow you to get important information
delivered right to your mobile phone. Please note, standard text messaging rates apply and you may unsubscribe at any time.

CHARITABLE REGISTRATION: If your company receives contributions, donations or grants, registration as a charitable organization may be required. Contact
our office for more information or visit our web site atwww.wvsos.gov.

WITHDRAWAL: A foreign corporation is a legal entity which can only withdraw its Certificate of Authority through formal action - not by submitting a letter or
making a phone call to the Secretary of State. To withdraw from its Certificate of Authority, a foreign corporation must file the Application for Certificate of
Withdrawal from Certificate of Authority (Form CF-5) and pay the withdrawal fee. You remain liable for all taxes, assessments, fines, penalties and interest until
you receive a Certificate of Withdrawal from the Secretary of State. Contact our office for more information.

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West Virginia Secretary of State
Business & Licensing Division
Tel: (304) 558-8000
Fax: (304) 558-8381
Website: www.wvsos.gov
Rev. 9/2018

Filing Submission Instructions - Business Division

IMPORTANT: READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING FORMS.
Please follow the instructions included with the application. Failure to include any of the required information on the form may
cause the filing to be rejected.

All forms may be downloaded from our web site www.wvsos.gov.

SUBMIT THE COMPLETED APPLICATION WITH THE CUSTOMER ORDER REQUEST FORM TO ONE OF THE
OFFICES BELOW. CHOOSE EXPEDITED OR STANDARD PROCESSING SERVICE. IF NOT USING THE CUSTOMER
ORDER REQUEST FORM AND YOU ARE REQUESTING EXPEDITED SERVICE, YOU MUST INCLUDE THE WORD
"EXPEDITE" AND THE LEVEL OF EXPEDITED SERVICE BEING REQUESTED (24-HOUR, 2-HOUR OR 1-HOUR) IN
YOUR CORRESPONDENCE. BE SURE TO INCLUDE THE CORRECT ADDITIONAL EXPEDITED FEE. THIS FEE IS IN
ADDITION TO THE REGULAR FILING FEE (SEE FEES BELOW).

CHOOSE ONE OF THE FOLLOWING PROCESSING SERVICES:
1 EXPEDITED SERVICE (24-hour,2-hour and 1-hour; *Requires standard filing fee plus additional expedite fee, see below)

Expedite Service *Fee EXPEDITED SERVICE requests may be submitted by:
24-Hour $ 25.00 - E-mail to efilings@wvsos.gov
2-Hour $250.00 - Fax
1-Hour $500.00 - Walk in delivery

2 STANDARD PROCESSING (5-10 business days)
Standard filing fees apply. STANDARD PROCESSING requests may be submitted by:
- E-mail to CorpFilings@wvsos.gov
- Fax
- Walk in delivery (drop off service only filed within 5-10 business days)
INCLUDE PAYMENT:
Be sure to enclose the correct filing fee with your filing. If paying by credit card, be sure to include the e-Payment Authorization
form with your filing. Your filing will be rejected if the payment is not included or if the e-Payment Authorization form is not
included if paying by credit card.

SUBMIT COMPLETED FILING TO ONE OF THE BUSINESS CENTERS BELOW:

BUSINESS SERVICE CENTERS
Standard and Expedited Filings

Charleston Office Clarksburg Office Martinsburg Office
One-Stop Business Center North Central WV Business Center Eastern Panhandle Business Center
1615 Washington Street East 200 West Main Street 229 E. Martin Street
Charleston, WV 25311 Clarksburg, WV 26301 Martinsburg, WV 25401
Phone: (304) 558-8000 Phone: (304) 367-2775 Phone: (304) 356-2654
Fax: (304) 558-8381 Fax: (304) 627-2243 Fax: (304) 260-4360
Hours: Mon. - Fri. 8:30a - 5:00p EST Hours: Mon. -Fri. 9:00a - 5:00p EST Hours: Mon. - Fri. 9:00a - 5:00p EST

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                                                                                                                     West Virginia Secretary of State 
                                                                                                                      Business & Licensing Division 
                                                                                                                      Tel: (304)558-8000 
                                                                                                                      Fax: (304)558-8381 
                                                                                                                      Website: www.wvsos.gov
Rev. 9/2018

 Customer Order Request                              SUBMIT THIS COMPLETED FORM WITH YOUR FILING.

           READ CAREFULLY BEFORE SUBMITTING - Expedite service is NOT AVAILABLE for the following filings:
             >> Tax Department filings including Sole Proprietorships, General Partnerships, and Associations 
             >> Dissolution or Withdrawal of Corporation, Voluntary Association or Business Trust

 Order Processing Requested*:          * * *  Expedite Processing Requires Additional Fees  * * *                   
     Standard Processing**                         24-HOUR Expedite***          2-HOUR Expedite                        1-HOUR Expedite
    (Avg. processing turnaround     (additional $25.00 fee included)       (additional $250.00 fee included)          (additional $500.00 fee included)
     5-10 business days)
 Email to: CorpFilings@wvsos.gov                                 Email to: eFilings@wvsos.gov

 *"Processing" indicates the filing will be completed and registered in the Secretary of State registration database. 
 **Standard Processing applications received byE-MAIL or FAXmust   include the e-Payment Authorization form with credit card information.     
 ***NOTE: Orders filed in person through any Secretary of State office location requesting the filing be processed will be assessed a 24-HOUR 
 Expedite fee of $25.00 per order.

Name of Entity:

Return filing to: 
(Return Address)

Contact Name:                                                              Phone: 

Return Delivery Options: Email or Fax options do not receive a copy via mail; must be ordered separately.
   Email to:                                                           Fax to: 

   Hold for Pick Up               Mail to Return Address above         FedEx:  Acct #

   Other (explain below):                                              UPS:  Acct #

Order Description (include items being ordered and fee breakdown):

* PLEASE NOTE: Original paperwork is kept by this office. Include a copy of the original filing if  
you want a file stamped copy returned to you at no extra charge. Certified copy requests are an     Total Amount:
additional $15 per certified copy being requested.
Payment Method:
   Check/Money Order                Credit Card    (Must attach e-Payment Authorization request form including payment information.)
   Cash (Do Not mail cash)           Pre-paid Acct #:                      Attach signed pre-paid slip.

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MAC WARNER
Secretary of State 24-hour, 2-hour and 1-hour
State Capitol Building
Charleston, WV 25305
Phone: (304) 558-6000 Expedite Service Guidelines
Website: www.sos.wv.gov

IMPORTANT: To ensure expedited service, please mark “EXPEDITE” in a conspicuous place at
the top of the service request. Please indicate method of delivery.

24-HOUR EXPEDITE SERVICE

The Secretary of State offers a 24-hour expedite service on most business organization filings processed by this office. If
you choose to utilize this service, please enclose with your filing the additional expedite fee. Please note that this expedite
fee is in addition to the standard fee charged on each filing and/or order. You must mark the document with your “24-HOUR
EXPEDITE” request. If using a cover letter, note that you are requesting 24-hour expedited service, and include your
telephone number and return information. Each filing will be returned by U.S.P.S. regular mail unless other arrangements
are made. This office does not fax confirmation of a 24-hour expedite.

The fee for 24-hour handling is $25.00 in addition to the usual fee for service. Please consult our fee schedules for the
appropriate fee. If you require assistance, please contact this office.

Time Constraints: Under most circumstances, each filing submitted receives same day filing date and may be picked up in
the office by the end of the same business day. Filings to be mailed the next business day if received by 2:00 pm of receipt
date and no later than the 2nd business day if received after 2:00 pm. Expedite period begins when filing or service request
is received in this office in acceptable fileable form.

2-HOUR EXPEDITE SERVICE

The Secretary of State offers a 2-hour expedite service on most filings processed by this office. If you choose to utilize the
2-hour expedite service, please enclose with your filing an additional $250.00 per filing and/or order. Please note that this
expedite fee is in addition to the standard fee charged on each filing and/or order. Complete and submit the 2-hour
customer order instruction form. If not using our order form, state clearly in your cover letter that you are requesting 2-hour
expedited service and include your telephone number and return information. Attach the order form or cover sheet to the
top of your filing and submit to this office. Each filing will be returned by U.S.P.S. regular mail unless other arrangements
are made.

1-HOUR EXPEDITE SERVICE

The Secretary of State offers a 1-hour expedite service on most filings processed by this office. If you choose to utilize the
1-hour expedite service, please enclose with your filing an additional $500.00 per filing and/or order. Please note that this
expedite fee is in addition to the standard fee charged on each filing and/or order. Complete and submit the 1-hour
customer order instruction form. If not using our order form, state clearly in your cover letter that you are requesting 1-hour
expedited service and include your telephone number and return information. Attach the order form or cover sheet to the
top of your filing and submit to this office. Each filing will be returned by U.S.P.S. regular mail unless other arrangements
are made.

1-Hour and 2-Hour Time Constraints: Each filing submitted for either 1-hour or 2-hour expedite receives same day filing
date and will be acknowledged by fax or e-mail within expedite service time. Failure to indicate method of acknowledgement
(fax or e-mail) or to provide a correct fax number or e-mail address may prevent the Secretary of State from acknowledging
the filing of such documents. Filings may be picked up within the expedite service period. Filings to be mailed will be mailed
out no later than the next business day following receipt. Expedite period begins when filing or service request is received in
this office in fileable form.

The Secretary of State reserves the right to extend the expedite period in times of extreme
volume, staff shortages or equipment malfunction. These extensions are few and will rarely
extend more than a few hours.
WV Secretary of State Expedite Guidelines
Effective: 8-31-17

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                                                                                         West Virginia Secretary of State 
                                                                                              Business & Licensing Division 
                                                                                                                        Tel: (304)558-8000 
                                                                                                                        Fax: (304)558-8381 
                                                                                               Website: www.wvsos.gov
                                                                                                                              Rev. 11/2017
                                                                                         USE BLACK INK ONLY - DO NOT HIGHLIGHT 
e-Payment Authorization                 This document contains confidential financial information and will be properly shredded after payment 
                                        has been processed by this office. Electronic storage of payment information is only permitted by signed 
                                        authorization below which may be retracted at any time by written request by the authorized party.
Service Type:       Fax      E-mail        Mail

Payment by Card     (card holder name and billing address required below)

Card Type:           Visa               Mastercard                 Discover              American Express

Credit Card Number:                                                                           V Code*

  * 3-digit number on back of VISA, MasterCard and Discover cards. 
     4-digit number on front right side of American Express card.
NOTICE: For security and verification purposes, all credit card payments must include the 3- or 4-digit CVV2 code (V Code) number 
located on the credit card. Failure to include this code will result in the rejection of your filing or service request.

Credit Card Expiration Date: Month:                                Year:

                                                                   Amount to Charge Card: USD $
Order Information    (required) 

Entity Name: 

Card Holder Information: 
  Name as it appears on the account
                    Billing Address

                             City                                           State             Zip Code

                        Telephone                                    Ext.

Payment Information Storage Authorization  (optional) 
I authorize the Secretary of State to store this payment information for future payment transactions processed by Secretary of State:
X                                                                Date
Authorized Signature 

Payment Authorization        (required) 
I authorize the Secretary of State to bill an amount not to exceed the following to be charged to the above listed account(s):

X                                                                Date
Authorized Signature 
                                Reset Form                         Not to Exceed Amount: USD $

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