Arizona LLC Application to Reserve Name Form

Should an LLC elect to reserve a business name prior its official registration with the Secretary of State, its representative must fulfill this form and submit it to Arizona’s Corporate Commission.Download

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DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY. 	
APPLICATION TO RESERVE LIMITED LIABILITY COMPANY NAME 	
Read the Instructions
1.  NAME TO BE RESERVED  –
see Instructions L001i	
 for name requirements for different entity 
types.  Enter the exact name or exact fictitious name to be reserved: 	
_______________________________________________________________________ \
	
2. TYPE OF ENTITY  –
 check only one  to indicate the type of entity that may be formed: 	
     LIMITED LIABILITY COMPANY  
     PROFESSIONAL LIMITED LIABILITY COMPANY  	
3.    APPLICANT  –
name and address of the individual or entity that will own the name reservati\
on: 	
Name 
Address 1 
Address 2 (optional) 
City 
State or Province Zip 
Country 	
SIGNATURE: 
 I ACCEPT 
Signature        Printed Name 
Date (mm/dd/yyyy)
REQUIRED – 
check only one:
I am the  Applicant  (I am an individual or 
natural person and not an entity).   The 
Applicant is an entity
 and I am its duly 
authorized agent. 
Filing Fee:  $10.00 (regular processing) Expedited processing – add $35.00 to filing fee.  
All fees are nonrefundable - see Instructions.       Mail:     Arizona Corporation Commission  
            Corporate Filings Section 
            1300 W. Washington St., Phoenix, Arizona  85007 
Fax:      602-542-4100
Please be advised that A.C.C. forms reflect only the 
minimum provisions required by statute.  You should seek private legal counsel \
for those matters that may pertain 
to the individual needs of your business. 
All documents filed with the Arizona Corporation Commission are  public record and are open for public inspection.  
If you have questions after reading the Instructions, please call 602-54\
2-3026 or (within Arizona only) 800-345-5819.
L001.001                                           Arizona Corporation Commission \
–  Corporations Division 
Rev: 2010                                                                           P\
age 1 of 1 	
 L001i	
By checking the box marked "I accept" below, I acknowledge under penalty of perjury 
that this document together with any attachments is submitted in complia\
nce with 
Arizona law.