COMMERCIAL REGISTERED AGENT REGISTRATION
(PLEASE TYPE OR PRINT CLEARLY IN INK)
1.
Name of individual or entity: ______________________________________________________________________________ Fictitious name: ________________________________________________________________________________________
2. 3.
Jurisdiction: ___________________________________
If entity, type of entity: __________________________________
Street Address
Street address of registered agent for service of process (In Arkansas):________________________________________ _______________________________________________________________________________________________________
Street Address Line 2 City, State Zip
4.
Mailing Address: ________________________________________________________________________________________
Mailing Address Line 1
_______________________________________________________________________________________________________
Mailing Address Line 2 City, State Zip
5.
Information regarding alternate means of accepting service of process:_________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________
The above referenced individual or entity intends to be in the business of serving as a Commercial Registered Agent in Arkansas in accordance with Act 15 of 2007.
I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State is a Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days. Executed this _______________ day of ___________________, ___________________.
___________________________________________________
Signature of Authorized Individual
_______ __________________________________________
Printed Name and Title of Authorized Individual
$50.00 Filing FEE made payable to the Arkansas Secretary of State
CRA-R Rev. 08/07