| Welcome to SEC Connect! |
|
| Before we get started, please provide the following information: |
| Filing Company’s Name:* |
|
*required |
| Filing Company’s Contact:* |
|
|
| Billing Address:* |
|
|
| City* |
State:*
Zip:*
|
|
| |
|
|
| Mailing Address:* |
|
|
| City* |
State:*
Zip:*
|
|
| |
|
|
| Phone Number:* |
|
|
| Email:* |
|
|
| IRS Employer Identification No.: |
|
|
| CIK Number: |
|
|
| CCC Number: |
|
|
| |
|
|
| Company's Fiscal Year End: |
|
|
|
|
| I’m Interested in Being Billed: |
|
|
| My Account Executive: |
|
|
| By submitting the information requested, and utilizing our filing and other services, you agree to hold SEC Connect, LLC, it's officers, directors, employees and agents harmless from any and all claims, liabilities, losses, damages and/or expenses, including attorney's fees, in connection with the performance of filing and other services provided by SEC Connect, LLC. Any liabilities that we may incur in connection with our provision of filing and other services shall be limited to and shall not exceed the fees actually paid to us. In no event shall we be liable for special, indirect or consequential loss or damage of any kind whatsoever.
|
|
 |
