Registered Agent Consent Form

Registered Agent Consent Form

Registered Agent Consent Form

 

Consent to Appointment by Registered Agent
I, , registered office located at
(name of registered agent)
voluntarily consent to serve

*(registered office physical address, city, state & zip)
as the registered agent for (name of business entity)
I hereby certify that I am in compliance with the requirements of W.S. 17-28-101 through W.S. 17-28-111.
Signature:__________________________________________

Date:
Print Name:

Daytime Phone:
Title:

Email:
Registered Agent Mailing Address
(if different than above):
*If this is a current registered agent changing their registered address on file, complete the following:
Previous Registered Office(s):
I hereby certify that:
• After the changes are made, the street address of my registered office and business office will be identical.
• This change affects every entity served by me and I have notified each entity of the registered office change.
• I certify that the above information is correct and I am in compliance with the requirements of W.S. 17-28-101 through
W.S. 17-28-111.

Signature: __________________________________________

Date:

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