Your Name *

First Name

Last Name

Phone *

(###)

###

####

Has your Principal Address changed during the last year? *

The principal address is the physical location of your company or nonprofit.

Yes

No

If "yes", please provide your new Principal Address.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Has your Mailing Address changed during the last year? *

Yes

No

If "yes", please provide your new Mailing Address.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Have you changed your registered agent during the past year? *

This is the person or company that is registered with the state to receive all official correspondence.

Yes

No

If "yes", what is the name and address of the new registered agent?

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

If you are a corporation, have your officers or directors on your board changed during the last year?

Yes

No

If you are a Limited Liability Company (LLC), who is your Manager?

The "manager" is the person who is designated to run the day-to-day operations.

First Name

Last Name