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APPLICATION TO RESERVE A NAME Vermont Secretary of State, 128 State Street Montpelier, VT 05633-1104 Phone: 802-828-2386 Proposed name:

(Alternate name)

Reserved by: Reserved for: Address of owner: City State: zip:

Intend to qualify a foreign corporation; Intend to qualify a foreign limited liability company; Intend to incorporate a Vermont domestic corporation; Intend to organize a Vermont domestic limited liability company; Intend to register a trade name; (name cannot include a corporate indicator) Intend to register a partnership; Intend to amend the name of a company already registered - the current name is:

Proposed business purpose: A reservation is good for 120 days, renewable twice. The owner of a reserved name may transfer the reservation to another person by delivering to the Secretary of State a signed notice of transfer that states the name and address of the tranferee. I understand that this reservation will expire in 120 days and the appropriate application for the business indicated above still needs to be filed before business activities can begin. Signature_________________________________Title: The filing fee is $20.00. File in duplicate with a self-addressed envelope. This reservation will expire 120 days from registration date:______________ Date:

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