Arkansas Secretary of State

John Thurston

1401 W. Capitol, Suite 250, Little Rock, AR 72201

501-682-3409 • www.sos.arkansas.go

Apostille/Certificate of Authentication Request Form

Submit this form with your documents. Please print or type.

Country documents will be used in:

Number of documents to be authenticated:

Requestor's Name:

Name of Firm/Organization (If applicable):

Address:

Daytime telephone number:

Email address:

Fees Calculation:

Apostille: Number of Document: X $10.00 per document = Net Total:

Certification: Number of Document" X $10.00 per document = Net Total:

Fee Amount Due:

Form of Payment Enclosed or Authorized:

Check drawn on U.S. bank (Checks/Money Orders must be payable to Arkansas Secretary of State.)

Money Order from a U.S. bank

Note A 4% conveience fee will be added to all credit / depit card transactions

Credit/Debit Card:

Visa

MasterCard

American Express

Discover

Name as it appears on Card:

Billing Address:

City: State: Zip Code:

Card Number:

CVV#: Expiration:

Payment Authorization; I authorize the Arkansas Secretary of State to charge my credit/debit card for the amount due for the authentication
services provided by the Secretary.

Cardholder’s Signature:

Date:

If the name on the credit card or debit card is in the name of a corporation or other business entity, please print the signer’s name:

Return Mail Address:

(Address where you would like the apostille/certificate and documents sent.)

Name:

Street Address or P.O. Box:

City:

State:

ZIP Code:

Location for Mailed Requests and In-Person Deliveries:

Arkansas Secretary of State

1401 W. Capitol, Suite 250

Little Rock, AR 72201

ARF-01 (Rev. 10/15)

Shipping Options

I have my own shipping account. I will upload my digital prepaid shipping label (FedEx, UPS, USPS, or DHL) in PDF format

I would like to buy a 2 days FedEx envelop to ship and return my documents for a fee of $10.00 each. A total of: $20.00

I would like to buy a Next day FedEx envelop to ship and return my documents for a fee of $25.00 each. A total of: $50.00

Shipping from my address to

ORIGIN ID:GBOA

UNITED STATES

ACTVVGT: 0.20 LB

CAD:119084289/WSXI3400

BILL SENDER

REF:

INV:

PO: DEPT:

5678FGH657

TRK#
0201

7946 3014 0400

SE GBOA

Thu - 10 Sep

** 1,2 DAYS **

- US

Shipping from to my address