If subscribed to Computershare’s Managed Annual Report Service, Customer must accurately maintain the following data points up to 90 days prior to the annual report filing deadline.

Corporations LLCs
Entity Name Entity Name
Jurisdiction of Entity Jurisdiction of Entity
Domestic Entity or Foreign Qualification? Domestic Entity or Foreign Qualification?
Principal Address (Business Address) Principal Address (Business Address)
Mailing Address Mailing Address
Corporate Phone Number Corporate Phone Number
Officers Managers
Officers Title Managers Title
Effective Date of Title Effective Date of Title
Officers Address Managers Address
Directors Members
Directors Address Members Address
Principal Business Activity Principal Business Activity
Fiscal Year End Fiscal Year End
EIN Number EIN Number
NAICS Code NAICS Code
Public or Private Company Public or Private Company
Class of Shares E-Filing Signatory