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Attention: The originator ID for ACH transactions changed on March 1, 2016. If your bank requires an originator id, the new originator id for ACH Debits is 1522077581 - please add this id with them immediately.

Application for Registration

of Fictitious Name

Pursuant to the provisions of Section 95 of the Arkansas Business Corporation Act (Act 576  of 1965), the undersigned corporation hereby applies for the registration of the use of a fictitious name and submits herewith the following statement:

1. The fictitious name under which the business is being, or will be, conducted by this corporation is:
2. The character of the business being, or to be, conducted under such fictitious name is:
3. a) The corporation name of the applicant:
b) The State of incorporation is:
c) The location (giving city and street address) of the registered office of the applicant corporation in Arkansas is:
Street Address:
4. The applicant states that if it is a foreign corporation that it is admitted to and authorized to do business in the state of Arkansas.
Name of Applicant Corporation:
Name of President:
Street Address:
2 Letter Abbreviation ZIP: -
Attest by Secretary:
I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State is a Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days.

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