Alabama LLC Credit Card Payment Slip Form

Should an Alabama-based LLC decide to pay for a filing fee via a credit card, representative must fulfill this slip prior to the transaction. This slip can be used for any type of submission/application.

Extracted Text for Proper Search

STATE OF ALABAMA 
OFFICE OF THE SECRETARY OF STATE  
BUSINESS SERVICES DIVISION 
FAX (334) 240-3138 	
 
 
MAILING ADDRESS	
        
PHYSICAL ADDRESS	
PO Box 5616        RSA Union Bldg, Suite 770 
Montgomery, AL  36103-5616          100 North Union Street 
         Montgomery, AL  36130 
 
 
 
CREDIT CARD PAYMENT SLIP  
  (Visa, MasterCard, Discover, and American Express) 
Card Type:     
 
 
Card Number:        
 
Expiration Date (Mo/Yr  – 4 digits required):  / 	
 
 	
 
 
Card Holder Name:            
 
 
Billing Address:            
 
City/State/Zip:   
        	
,  	     	
 
 
 
 
Typed Name of Authorized Signature:         	
**Name should only differ from Card Holder  if this is a corporate/business card. ** 
 
   
Authorized Signature for Card Holder:         	
CC SLIP – 8/2010