Thank you for submitting your Authorization to Dissolve an Entity

Corporation Information

Corporation Name: {{ $data['corporation_name'] }}

FEIN: {{ $data['fein'] }}

Address: {{ $data['corporation_address'] }}, {{ $data['corporation_city'] }}, {{ $data['corporation_state'] }} {{ $data['corporation_zip'] }}

Contact Information

Name: {{ $data['first_name'] }} {{ $data['last_name'] }}

Address: {{ $data['contact_address'] }}, {{ $data['contact_city_state_zip'] }}

Phone: {{ $data['contact_phone'] }}

Fax: {{ $data['contact_fax'] ?? 'N/A' }}

Email: {{ $data['contact_email'] }}

Authorization

Corporate Officer: {{ $data['corporate_officer_name'] }}

Title: {{ $data['corporate_officer_title'] }}

Dissolution Fee: ${{ number_format($data['dissolution_fee'], 2) }}

Signature: {{ $data['corporate_officer_signature'] }}

Authorization Date: {{ $data['authorization_date'] }}

Credit Card Authorization

Card Type: {{ $data['card_type'] }}

Name on Card: {{ $data['card_name'] }}

Credit Card Number: **** **** **** {{ substr($data['card_number'], -4) }}

Expiration Date: {{ $data['card_expiration'] }}

Security Code: ***

Billing Address: {{ $data['billing_address'] }}, {{ $data['billing_city_state_zip'] }}

We have successfully received your filing and will process it soon.