UTAH SUPREME COURT 450 South State Street PO Box 140210 Salt Lake City, UT 84114-0210 Phone number: 801-238-7967 Fax: 801-578-3999 REQUEST FOR CERTIFICATE OF GOOD STANDING Please note: The fee for a certificate of good standing is $15.00 per certificate. Payment is due in advance by check or credit card if item is to be mailed. Make checks payable to Utah Supreme Court. Credit card information will be verified under separate cover. Name:________________________________ Bar Number:__________ Daytime Phone No._____________________ Please spell your name as you want it to appear on your certificate: _________________________________________________________ Quantity: ______ Payment method: (Please select) Certificate(s) to be paid for at time of pick-up. Enclosed is a check for certificate(s). Supreme Court to call applicant for credit card information. Delivery method: (Please select) Supreme Court to mail certificate(s) to the following address: ______________________________________ ______________________________________ ______________________________________ ______________________________________ -OR- Supreme Court to call applicant when certificate is ready for pick-up. Signature of applicant:___________________________________ Date:________________ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + For office use only: Request is being made by phone or in person. Credit card information confirmed by phone or in person at time of request. 04-2006 Clear Form Print Form