SCOTT SCHWAB Kansas Secretary of State

STATE OF KANSAS

Memorial Hall, 1st Floor 120 SW 10th Avenue Topeka, KS 66612-1594 785-296-4564 http://www.sos.ks.gov

To request an online UCC Entity account, fill out the form below, print, and fax or email to our office.

Kansas Secretary of State
Attn: UCC
120 SW 10th Avenue
Topeka, KS 66612

Fax # 785-296-4570    Email kbc@ks.gov

The online UCC Entity application is free. Once an account is created, you may enter bank information for payment of UCC filings.

Your request will be processed by our UCC department and you will receive an activation email within two business days of faxing.

Entity/Company Information

Entity Name (company name):

Contact Name (individual name):

Entity Address 1:

Entity Address 2:

Entity City:

Entity State:

Entity Zip Code:

Entity Phone:

Entity Fax:

Contact E-Mail:

Your Name:

Date: 3/28/2023