Business Fax Cover Sheet - Maryland
Maryland
SDAT CORPORATE CHARTER DIVISION
E
xpedited Request by Fax Cover Sheet
Note: All faxed filings and requests are expedited and an expedited filing surcharge beyond the processing fee applies to each request.
See Fee Schedule at http://www.dat.state.md.us/sdatweb/
FEES.pdf for the appropriate fees or e-mail the division at sdat.charterhelp@maryland.gov or
telephone for new filings only 410-767-1340, for all other calls 410-767-1350.
_____________________________________________________________________________________________________________________
Fax all requests to 410-333-7097 Please type or print legibly, you may also fill this form out on your pc.
Name of entity:_______________ _________ ___________________________ __________________________ _______________
Fax number:_______ __________ __________________________________
Phone number:_________________________________________________ Number of pages transmitted:_____ _____________
Contact person :___________________ __________________________ __________ ___
Name and address for return mail:______ __________ _________ ___________________ __________ __________ _____________
________________________________________________________________________________________________________
SERVICE REQUESTED Check all that apply.
NEW ENTITY FILING File document Return original document Note a $5.00 fee applies to this service
Certified copies of document being filed _______Numb er of certified copies
Short form Certificate of Statu s _______Numb er of certificates
RECORD REQUEST Department ID number____________________________________
Entity name______________________________________________________________________________________________
Certificate of Status for existing entity ________Number of certificates
Copies of documents previously recorded
Attach separate sheet and specify: the name and title of each document; the date of recording, if known; liber and folio, if known;
the number of copies wanted for each document.
_____________________________________________________________________________________________________________________
This transaction will not be accepted without the followi ng:
CREDIT C A RD INFORM ATION
O MASTERCARD O VISA (At this time we only accept Mastercard and VIsa)
Cardholder's name______________________________________________________________________________
Credit card number_____________________________________________________________________________
Billing address and zip code ______ _________ ___________ ___________ ___________ ___________ ___________
___________
__________________________________________________________________________________
Expiration date_
___________________________________ 3 Digit security code____________________________
Signature of Cardholder__________________________________________________________________________
=======
=====================FOR DEPARTMENTAL USE ONLY=================================
AUTH NO.______________________CLERK:__________________FEE:____________________
Revised: 10/8/14
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