Pre-Paid Account Set Up Slip Template

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)