Get H: Home Forms Msbde Forms-request For Corporate Or Trade ...

Filling out the H: HOME FORMS MSBDE Forms-request For Corporate Or Trade Name is an essential step for those seeking approval for a corporate or trade name with the Mississippi State Board of Dental Examiners. This guide will provide you with clear, step-by-step instructions to complete the form online efficiently.

Follow the steps to fill out the form accurately.

1. Click the ‘Get Form’ button to access the form and open it in your editing application.
2. Input the dentist's name in the designated field labeled 'DENTIST NAME'. Make sure to enter the full name as recognized by official documents.
3. Enter the current date in the 'DATE' field. This should reflect the date you are completing the form.
4. In the 'CORPORATE/TRADE NAME REQUESTED' field, provide the proposed name you wish to use for your business. Ensure this name complies with the regulations set by the board.
5. If applicable, list any additional dentists affiliated with your facility in the 'ADDITIONAL DENTISTS AFFILIATED WITH FACILITY' section.
6. Fill in the facility's street address in the 'FACILITY “STREET” ADDRESS' section, ensuring all details are accurate.
7. Provide the mailing address in the 'FACILITY “MAILING” ADDRESS' field. This may differ from the street address.
8. Input the facility telephone number where you can be reached in the 'FACILITY TELEPHONE' field.
9. If applicable, enter the facility's facsimile number in the 'FACILITY FACSIMILE' section.
10. Provide a valid email address in the 'FACILITY E-MAIL' field for correspondence regarding your application.
11. In the 'ADDITIONAL INFORMATION OR FACILITY LOCATIONS' section, add any necessary details that may help the board with your application.
12. Once you have completed the form, review all entries for accuracy. You can then save changes, download, print, or share the form as required.

Complete your application online today to ensure your corporate or trade name is properly submitted!