Fillable Online Herschler Building East, Suite 101 122 W 25th ... 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the name of the registered agent in the designated field. Ensure that this is accurate as it will be used for official purposes.
3. Next, provide the physical address of the registered office, including city, state, and zip code. This information is crucial for compliance.
4. Fill in the name of the business entity for which you are consenting to serve as a registered agent.
5. Sign in the signature field provided. This must be executed by the registered agent themselves.
6. Enter the date in mm/dd/yyyy format to indicate when you are completing this form.
7. Complete additional fields such as your printed name, daytime phone number, title, and email address. Note that an email is required for important notifications.
8. If your mailing address differs from your registered office address, provide that information in the specified section.

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