REGISTERED AGENT CONTACT INFORMATION


Please complete the fields below.

CONTACT INFORMATION

Principal Business Office

Company Name:
Address:
Address 2:
Address 3:
City:
State/Province:
Postal Code:
Telephone:
Affiliated/Parent Company (if applicable):
State(s) where this entity is appointing COGENCY GLOBAL INC. as agent:

If this is an appointment in Wyoming for a domestic entity, please complete this additional form and upload with your submission.

Only PDF uploads will be accepted!

Fiscal Year End:
Is this a Benefit Corporation or LLC?

YOUR REFERENCE INFORMATION (OPTIONAL):

Reference/Matter Number or Description:
Name of Partner / Attorney in Charge:
LEGAL MATTERS TO
Contact:
Company/Firm:
Address:
Address 2:
Address 3:
City:
State:
Zip:
Phone:
Email:
Additional Contact:
CC Contact:
CC Contact Email:
TAX NOTICES TO
Contact:
Company/Firm:
Address:
Address 2:
Address 3:
City:
State:
Zip:
Phone:
Email:
Additional Contact: (optional)
CC Contact:
CC Contact Email:
RENEWAL INVOICES TO
Contact:
Company/Firm:
Address:
Address 2:
Address 3:
City:
State:
Zip:
Phone:
Email:
Additional Contact: (optional)
CC Contact:
CC Contact Email:

Important Note:

There are several states (see below) that require by statute that the Registered Agent maintain in its records the name, address, and phone number of a natural person (i.e. John Smith) or records maintenance person as the "Communications Contact" for the entity for law enforcement purposes.

We will consider your designated contact person for legal matters to be the company's "Communications Contact" for this purpose unless you check the box above and indicate otherwise.

COMMUNICATIONS CONTACT
Contact:
Company/Firm:
Address:
Address 2:
Address 3:
City:
State:
Zip:
Phone:
Email:
SUBMIT
Your Name:
Your Phone:
Your Email:
Contact COGENCY GLOBAL with any questions!

IMPORTANT NOTICE REGARDING:

Delaware, Indiana, Kentucky, Nevada, Oklahoma and Wyoming

In addition to completing the contact information to ensure timely delivery of important tax notices and Service of Process, please note there are a number of states, including Delaware, Indiana, Kentucky, Nevada, Oklahoma and Wyoming that require that domestic and/or foreign entities provide their registered agent or the Secretary of State with the name, business address and business telephone number of a natural person who is designated the "communications contact" and authorized to receive communication from the Registered Agent.

If an entity fails to provide the required information, the agent is required to resign to protect its authority to serve as an agent in these jurisdictions.

**Please note that pursuant to Delaware law, the designated communications contact is required to know, or know how to contact, the appropriate business person with the entity should there be a request for the names and addresses of the entity's members or partners.

WYOMING DOMESTIC ENTITIES ONLY

In addition, Wyoming domestic entities are required to provide to either their registered agent or to the Wyoming Secretary of State the (I) names and addresses of all Directors, Officers or Managers or persons serving in a similar capacity; and (II) the name, business address and business telephone number of a natural person who is designated the "communications contact" and authorized to receive communication from the registered agent.

If an entity fails to provide the required information, the agent is required to resign to protect its authority to serve as an agent in Wyoming.

NEVADA

Nevada has specific records maintenance requirements for domestic and/or foreign entities depending on which type of entity is formed or qualified. Please contact your COGENCY GLOBAL service specialist for more information specific to your entity type.