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SECRETARY OF STATE
CORPORATIONS SECTION

PAYMENT FORM FAX: 512-463-5709

FOR CUSTOMER USE ONLY (PLEASE PRINT OR TYPE) Cardholder Name: Address: City : Phone No.: ( ) State: Fax No.: ( ) Zip:

TYPE DOCUMENT TO BE FILED:

ENTITY NAME(s):

SHIP TO ADDRESS: (if different than Address above)

EXPEDITED HANDLING REQUESTED:

YES

NO

(Additional charge of $25 per document for expedited service)

SELECT PAYMENT TYPE AND PROVIDE REQUESTED INFORMATION

Charge to: Secretary of State Client ID No.: (if applicable)
Charge to: VISA® MasterCard® Discover® Charge to: LegalEaseSM

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

* For information about LegalEaseSM, call 1-800-253-5749 Card No.: 5 0 0 6 7 9 Client No.: Signature: Case No.: -

Client Reference: (if applicable) (Not Secretary of State Client ID No.)

FOR SECRETARY OF STATE USE ONLY
AMOUNT FILING FEE EXPEDITED HANDLING FEE TOTAL AMOUNT
Form No. 807

BATCH NUMBER:

$

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(Rev. 09/06)