State of Alabama Office of the Secretary of State Uniform Commercial Code Division (334) 242-5231 Fax (334) 353-8269
Mailing Address Physical Address
Post Office Box 5616 Montgomery, Alabama 36103-5616
11 S. Union St. Ste. 200 Montgomery, AL 36104
Pre-Paid Account Set Up Slip
Account Name:___________________________________________ Account Contact Person: __________________________________ Telephone: ____-____-______ Address: __________________________________________ __________________________________________ City/St/Zip: _________________, _____ _______-______ Agent / Service you would like to have authorization to use this account (optional):
Signature: __________________________ Date: ___/___/_____
*The minimum for setting up a pre-paid account is $500.00. (Payable only by check)