| Appoint us
are your registered agent by completing the form below:
About
the entity for which we will serve as registered agent
(“Entity”):
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Entity’s name:*
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Please provide.
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(formal legal name,
including “inc” or “llc” etc
designator) |
Type of Entity:*
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Please provide.
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(e.g., corporation, limited liability
company, limited partnership etc) |
State Entity Formed In:*
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Please provide.
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(e.g., Georgia,Delaware, etc.) |
Entity’s notification address:*
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Please provide.
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(the address to which we would
mail notices, if requested, whether or not in Georgia) |
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Entity’s notification email (up
to 3 emails)
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Notification Email 1:*
Please provide.
Notification Email 2:
Notification Email 3:
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(where we would email notice to you –
this is very important as it is the primary means of
notifying you) |
| Entity’s fax number: |
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(to receive notices) |
Entity’s Phone Number:*
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Please provide.
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(to answer our questions) |
Entity’s “control number”
issued by the State of Georgia:*
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Please provide.
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(You can obtain this number by visiting
http://corp.sos.state.ga.us/corp/soskb/CSearch.asp and
typing in
your entity’s name) |
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Entity’s primary business address
in Georgia:
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(if any and different from above) |
| Entity’s Primary Contact Person’s
Name:* |
Please provide.
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Entity’s Primary Contact Person’s
Contact Information:
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Address:*
Please provide.
Email:*
Please provide.
Fax:
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(if different from above)
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Entity’s Additional Contact or
Copy-Notice:
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Address:
Email:
Fax:
Phone:
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(e.g., your attorney or another Entity
representative) |
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| Additional Comments, Information or Instructions:
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| About the individual completing
this form |
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| Your individual name:* |
Please provide.
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(“Individual”) |
The entity you represent, if any, in
addition to the Entity for whom we will act as registered
agent:*
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Please provide.
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(for example, a law firm name where the
person completing the form is a representative of the
firm completing this appointment for the client/Entity) |
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| If different from the Entity’s
Primary Contact’s Contact Information: |
Address:
Email:
Fax:
Phone:
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| I, the Individual named above,
hereby individually represent and warrant that I am
authorized to make this appointment and legally bind
the Entity named above for the purposes of this appointment.
If I indicated above that I represent an entity other
than the Entity for which CGA Admin, LLC will serve
as registered agent (e.g., a law firm), then my signature
below is on behalf of such entity (e.g., the law firm).
On behalf of the Entity, I hereby appoint CGA Admin,
LLC as the Entity’s registered agent in Georgia.
I hereby authorize CGA Admin, LLC to act as registered
agent and to do all things reasonably deemed necessary
or desirable, in CGA Admin, LLC’s discretion,
to fulfill its obligations as registered agent. This
appointment is made pursuant to the Terms
of Use in effect at the time of this appointment.
Additionally, I hereby grant a revocable power of
attorney to CGA Admin, LLC and pursuant thereto authorize
CGA Admin, LLC to execute documents in the Entity’s
name in order to implement this appointment or otherwise
serve as registered agent. Any revocation of this
power of attorney must be in writing and delivered
via email and facsimile to the contact information
set forth at www.cgaadmin.com at the time of the revocation.
The Entity agrees to pay the annual registered agent
fee of $150 via check made payable to “CGA Admin,
LLC” upon submission of this appointment for
the calendar year of the appointment, and, upon renewal
of the services, for each calendar year renewal term.
Mail all payments and communications of any kind to:
1000 Johnson Ferry Road, Suite A-125, Marietta, Georgia
30068. This address will also be your registered agent
address in Cobb County, Georgia.
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Your Name:*
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Please provide.
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(i.e., type your name - John Smith) |
Your Signature:*
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/
/
Please provide. |
(i.e., type your name inside “/”
to act as your legal signature - /johnsmith/) |
| Today’s Date:* |
Please provide.
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