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Fictitious Name Registration

Step 1 of 4 - Client Information

25%
Are you and existing client of Esquire Assist?(Required)
Return Document by
Address(Required)
I qualify for a veteran/reservist-owned small business fee exemption
Max. file size: 500 MB.
Number and Street, City, State, Zip, County (post office box alone is not acceptable)

The name and address, including number and street, if any, of each individual interested in the business is:

Name
Number and Street, City, State, Zip

Each entity, other than an individual, interested in such business is (are)

Name(Required)
Form of Organization(Required)
Organizing Jurisdiction(Required)
Principal Office Address(Required)
PA Registered Office(Required)
The applicant is familiar with the provisions of 54 Pa.C.S. § 332 (relating to effect of registration) and understands that filing under the Fictitious Names Act does not create any exclusive or other right in the fictitious name.(Required)
The applicant is familiar with the provisions of 54 Pa.C.S. § 332 (relating to effect of registration) and understands that filing under the Fictitious Names Act does not create any exclusive or other right in the fictitious name.
IN TESTIMONY WHEREOF, the undersigned have caused this Application for Registration of Fictitious Name to be executed this
MM slash DD slash YYYY
Individual Signature
Entity Name
Signature
By typing your name here you understand that the document will be digitally signed by you as if you manually signed a form.
Title
How would you like this form submitted?(Required)
Expedited Options(Required)
This field is for validation purposes and should be left unchanged.

Esquire Assist, Ltd.
  • Esquire Assist, Ltd.
  • 125 Locust St. Harrisburg, PA 17101
  • 717-232-9398
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