"*" indicates required fields
This form is for PLLC’s and PC’s.
Upon submission of this form, an email will be sent to the address provided above. The email will contain an attached PDF and a link to a PDF of the form you completed. Please print your form, include a copy of the Articles of Organization and return with payment.
Checks/money orders are made payable to NCBOESLPA, and should be mailed to: NCBOESLPA PO Box 16885 Greensboro, NC 27416
The form and check/money order MUST come together. If a check/money order comes in without a form, or vice versa, it will be returned to the sender.