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This form must be type written or computer generated.

Business Registration - Optional Inclusion of Ownership Data

State of Utah DEPARTMENT OF COMMERCE Division of Corporations & Commercial Code Application for Reservation of Business Name
Check Here If: Non-Refundable Processing Fee: [ ] New Filing $22.00 [ ] Renewal $22.00 File Number:

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The reservation is for 120 days, effective from date of approval. The reservation expires at 5:00 p.m. on the 120th day.

The Business Name to be Reserved: Please describe the intended business use of the reserved name:

This application is not for permission to use a business name. It is merely for a reservation of a name. The reservation of a business name does not create an ownership right in the name, nor may the name be used until the business entity is fully registered, authorized or incorporated under the laws of this State. In order to register a business entity under the reserved name prior to the 120 day expiration of the name reservation, the name reservation will need to be canceled. I do hereby certify that I have read the foregoing provisions and agree to comply therewith in making and submitting this application, Applicant Information: Applicant:
List the individual or business entity that will own the Name Reservation on the name line.

Name: _______________________________________________________________________________ Entity Number (if a registered business): ____________________________________________________ Address: _____________________________________________________________________________ City: ____________________________________________________ State: ________ Zip: ____________ Under penalties of perjury, I declare that this Name Reservation has been examined by me and is, to the best of my knowledge and belief, true, correct and complete. Signature:
Applicant must sign here after the form is printed

Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, you may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity.

Mailing/Faxing Information: www.corporations.utah.gov/contactus.html

Division's Website: www.corporations.utah.gov