State/County DBA Filing Form

State/County DBA Filing Form

DBA (Doing Business As) Registration Information Request Please complete the following form accurately to register your business name (DBA) with your county and state. Your cooperation ensures compliance and proper documentation. We will use this information in data to File the appropriate paperwork for your county and state to register your business name.
Name*

First NameLast Name
Assumed Business Name *
The entity’s principal office address is:*
The entity filing the assumed name is a: (Select the appropriate entity type below.)*
The file number, if any, issued to the entity by the secretary of state is:
Please enter N/A if do not apply.
The state, country, or other jurisdiction of formation of the entity is:*

Statement For Affidavit.

Authorization for DBA (Doing Business As) Filing
I, First Name Last Name hereby grant permission to The Brand Builder and its employees to file the DBA (Doing Business As) registration with my county and state on my behalf. I affirm that all information provided in this form is accurate and correct. Additionally, I specifically authorize Arthur Allen and Candace Lee, employees of Brand Builder, to submit this form to the relevant authorities.
By signing below, you confirm that all the information provided above is accurate and correct.

Signature:

X_______________________Date:_______________

{name}

---------------------------Notary Infomation-----------------------

Section 3: Notarizing Officer/Signature Guarantor Information & Stamp
Name of Notarizing Officer/Signature Guarantor: ______________________________________

Notary Commission/Identification Number: ___________________________________________

Name of Business/Other: _________________________________________________________

Street Address: __________________________________________________________

_________________
City, State, & ZIP Code: __________________________________________________________
Direct Business Phone Line: _______________________________________________________
Notarizing Officer Signature: x______________________________

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Place Notary Stamp/Signature Guarantee Stamp below and/or attach any applicable documents

Note: If the individual resides in California, please provide a Signature Guarantee
Should be Empty:

State/County DBA Filing Form

Statement For Affidavit.