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SECRETARY OF STATE STATUTORY DOCUMENTS SECTION P.O. BOX 13550, AUSTIN, TX 78711-3550

PAYMENT FORM FAX NO. (512) 463-0873 TEL NO. (512) 463-5705

PLEASE PRINT OR TYPE

Name of Cardholder: Name of Requestor: Billing Address:
Street City State Zip

Phone: Type of Document to be Filed: Name on Document:

Fax:

File Number:

Credit Card

OR

LegalEase
For information about LegalEase, call 1-800-253-5749.

Fees paid by credit card are subject to a convenience fee (currently 2.7%) of the total fees incurred. VISA MASTERCARD DISCOVER Card No.: Expiration Date: Signature: -

Account No.: Client. No.: Signature:

-

Case No.:

-

FOR SECRETARY OF STATE USE ONLY Employee Name: Date: Filing Fee(s): $ CID No.: S.O. No.: Search Fee(s): $ Certificate(s): $ Copies: $ Credit Card Convenience Fee (2.7%): $ Total Amount: $ PROCESSED REJECTED

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Revised: 06/2009

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Form 2101