Cooperative License Renewal Request
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1
2New Mexico
Secretary of State
Corporations Bureau
325 Don Gaspar, Suite 300 · Santa Fe, NM 87501
(800) 477-3632 ·
Cooperative License Renewal Request
Cooperative Name: ______________________________________
Business ID#: __________________________________________
License Period: ________________ TO
____________________
(Start date MM/DD/YYYY)
(End date MM/DD/YYYY)
____________________________________________________________________
Address you want license mailed to: (street address OR Post Office Box AND city, state & zip code)
Transaction Fee: $____________________________________________
Number of Members Served (Rural Electric ONLY): _________________
_____________________________________
_____________________________
Printed Name
Title
_____________________________________
_____________________________
Signature
Date Signed
Payment Information
Check/Money Order #: _________Date: ________ Amount: ________
If using a prepaid account please fill out authorization below
Prepaid Account Holders Name: _______________________________
Prepaid Account ID#: _________
Amount authorized from prepaid account for transaction: $_______
SOS-COOPLR-11/2016
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Parent category: Legal