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: Date:

The filing fee is $20.00.

File in duplicate with a self-addressed envelope.  
This reservation will expire 120 days from registration date:______________