MAIN OFFICE ACCOUNT INFORMATION:  (*Required Fields) 

       ID:*                       (If you are an existing service company or drawdown company, list your 
                                ID # assigned by the Department of State.  New companies will leave this 
                                field blank.) 

COMPANY    NAME:* 

ADDRESS:* 

CITY:                     STATE:*               POSTAL CODE:* 

PHONE:*  

FAX:*  

EMAIL:*  

CONTACT  NAME:*  

CONTACT  EMAIL:*  

DISTRIBUTION EMAIL:*  

REGISTERED AGENT: 
DO YOU WISH TO HAVE YOUR COMPANY INCLUDED IN THE REGISTERED AGENT LIST AVAILABLE TO SERVICE COMPANIES? 
                                                                                                        YES    NO 

DO YOU WISH TO HAVE YOUR COMPANY’S NAME LISTED FOR THE PUBLIC TO CHOOSE AS REGISTERED AGENT?            YES   NO 

ADDRESS:*  

CITY:*                    STATE:*             POSTAL CODE:* 
DOS-1952-f-a (Rev. 11/18)                                                                                  Page 1 of 4 

SERVICE OF PROCESS: 

DO YOU WISH TO HAVE YOUR COMPANY INCLUDED IN THE SERVICE OF PROCESS LIST AVAILABLE TO SERVICE COMPANIES? 
                                                                                                   YES    NO 

DO YOU WISH TO HAVE YOUR COMPANY’S NAME LISTED FOR THE PUBLIC TO CHOOSE FOR SERVICE OF PROCESS?    YES    NO 

ADDRESS:*  

CITY:*                    STATE:*                                    POSTAL CODE:* 

SETTINGS: 

REQUIRE DOUBLE KEY VERIFICATION OF ENTITY NAME DURING ONLINE FILING?                              YES     NO 

REQUIRE CUSTOMER REFERENCE NUMBER FOR ONLINE FILING?                                              YES     NO 

ALLOW USE OF DRAWDOWN ACCOUNT FOR ONLINE FILING?                                                  YES     NO 

DOS-1952-f-a (Rev. 11/18)                                                                              Page 2 of 4 

ACCOUNT ADMINISTRATORS:   - You may request up to three administrative accounts (*Required Fields) 

ADMINISTRATOR 1 

Name:*   

Phone Number:* 

E-Mail Address:*

ADMINISTRATOR 2 

Name:* 

Phone Number:* 

E-Mail Address:*

ADMINISTRATOR 3 

Name:* 

Phone Number:* 

E-Mail Address:*

DOS-1952-f-a (Rev. 11/18)                                                           Page 3 of 4 

INSTRUCTIONS: 

MAIN OFFICE ACCOUNT INFORMATION: 

ID – Existing Service Companies and/or Drawdown Companies – list your previously assigned ID# in this field.  Companies 
who are requesting Service Company (drawdown) status, leave field blank as this office will assign an ID# to you. 

MAIN OFFICE CONTACT INFORMATION FIELDS – Please list your company name, address and contact information 
including main contact person for your company. 

DISTRIBUTION EMAIL – This email ADDRESS will be the email address for your company in which all electronic filing 
receipts from online filing will be distributed.  You can establish a distribution list for this email address which will allow the 
distribution of electronic filing receipts to multiple recipients in your company. 

REGISTERED AGENT – Do you wish to have your company included in the drop down list available for online filing to 
service companies and/or the general public?  If “Yes” is indicated, your company name will appear in the drop down list for 
online filing certificates.  When a service company name is selected from the drop down list of an online filing, the Registered 
Agent fields will be automatically populated with the name and address of the service company selected.  You can access a 
report through your online login for a list of the entities that selected your company as Registered Agent. 

SERVICE OF PROCESS – Do you wish to have your company included in the drop down list available for online filing to 
service companies and/or the general public?  If “Yes” is indicated, your company name will appear in the drop down list for 
online filing certificates.  When a service company name is selected from the drop down list of an online filing, the Service of 
Process fields will automatically populated with the name and address of the service company selected.  You can access a 
report through your online login for a list of the entities that selected your company as Service of Process. 

REQUIRE DOUBLE KEY VERIFICATION OF ENTITY NAME WHEN FILING – Key verification of the proposed 
business entity name is the default setting for online filing of certificates.  If you wish to remove the key verification of the 
proposed entity name, please select “No” in the Require Double Key Verification of Entity Name when filing. 

REQUIRE CUSTOMER REFERENCE NUMBER WHEN FILING – If you wish to set the Customer Reference Number 
field as a required field for online filing, please select “Yes” in the Require Customer Reference Number when filing. 

ALLOW USE OF DRAWDOWN ACCOUNT - Please select “Yes” if you wish to have the drawdown account used for 
online filing. 

ACCOUNT ADMINISTRATORS: 
Each Service Company Main Office can designate up to three account administrators for the online filing account. 
Administrators will have the option to update information on file for the company, establish company logins and passwords 
and have access to additional reporting information. 

For each administrator provide the administrator name, contact phone number and email address. 

FEES: 
For a new Service Company/drawdown company, this application requires a minimum deposit of $100.00.  The 
application fee should be sent to the NYS Department of State, Division of Corporations, Attn: Lynn Coleman, One Commerce 
Plaza, 99 Washington Avenue, Albany, NY 12231 or fax the application and completed credit card/debit card authorization 
form to Lynn Coleman at (518) 474-1418.  As a service company you are required to have a drawdown account which will be 
established during the processing of your Application.  The minimum $100 deposit accompanying your application will be 
posted to this account for which you will be able to use these funds for transactions made with this office. 

DOS-1952-f-a (Rev. 11/18)                                                                                         Page 4 of 4