1. Name of my LLC:
2. The cost of the publication package for your county is a one time $(FILL AMOUNT) and no other costs will apply.
3. My Name:
4. My Company:
5. My Company Address:
6. City, State & Zip Code:
7. My Phone:
8. My E-Mail:
9. (CHECKBOX) I have attached (left) my Articles of Organization (NYS DOS) formation filing receipt.
10. SIGNATURE REQUIRED — ALL ORDERS:
11. (CHECKBOX) I am paying via ZELLE. The e-mail address for payment is publish@empirestatelegal.com
12. (CHECKBOX) Please charge this purchase to my credit/debit card, either VISA, AMEX or DISCOVER:
13. Cardholder Name:
14. Company:
15. Full Address:
16. Phone Number:
17. Card Number:
18. Expiration:
19. CVV:
20. AUTHORIZING SIGNATURE: