Online Incorporation Form

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Customer E-Mail

Important: Enter a valid e-mail address. Receipts will be sent to this address.

E-Mail:*

Incorporation Information

Name of Incorporation:*

Doing Business As (DBA):*

Second choice of name

Requested Date of Incorporation

Character of Business*

Short business description

OFFICIAL CORPORATE PHYSICAL ADDRESS

Address Line 1:*

PO Boxes are not allowed.

Address Line 2:

Apt. or Suite No.

City:*

State:*

Zip Code:*

Capitalization

Number of Shares/Certificates Authorized:*

Number of Shares/Certificates Issued:*

Stock Class

Corporate Officers

1ST OFFICER

1st Officer`s First Name:*

1st Officer`s Middle Initial:

1st Officer`s Last Name:*

1st Officer`s  Address Line 1:*

1st Officer`s Address Line 2:

Apt. or Suite No.

1st Officer`s City:*

1st Officer`s State:*

1st Officer`s Zip Code:*

1st Officer`s Phone:*

1st Officer`s County:*

1st Officer`s SSN:*

No Dashes

1st Officer`s % of Stock Ownership*

2nd Officer?

No Yes

2ND OFFICER

2nd Officer`s First Name:*

2nd Officer`s Middle Initial:

2nd Officer`s Last Name:*

2nd Officer`s Address Line 1:*

2nd Officer`s Address Line 2:

Apt. or Suite No.

2nd Officer`s City:*

2nd Officer`s State:*

2nd Officer`s Zip Code:*

2nd Officer`s Phone:*

2nd Officer`s County:*

2nd Officer`s SSN:*

No Dashes

2nd Officer`s % of Stock Ownership*

3rd Officer?

No Yes

3RD OFFICER

3rd Officer`s First Name:*

3rd Officer`s Middle Initial:

3rd Officer`s Last Name:*

3rd Officer`s Address Line 1:*

3rd Officer`s Address Line 2:

Apt. or Suite No.

3rd Officer`s City:*

3rd Officer`s State:*

3rd Officer`s Zip Code:*

3rd Officer`s Phone:*

3rd Officer`s County:*

3rd Officer`s SSN:*

No Dashes

3rd Officer`s % of Stock Ownership*

Statutory Agent

Statutory Agent same as Officer1?

No Yes

Statutory Agent`s First Name:*

Statutory Agent`s Middle Initial:

Statutory Agent`s Last Name:*

Statutory Agent`s  Address:*

Statutory Agent`s City:*

Statutory Agent`s State:*

Statutory Agent`s Zip Code:*

Statutory Agent`s Phone:*

Credit/Debit Card Holder Information

First Name:

Middle Initial:

Last Name:

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

Phone:

Credit Card Holder`s

Credit/Debit Card Information

Card Number:*

No dashes or spaces please

Expiration Month:*

From your card

Expiration Year:*

From your card

Card Brand:*

Charge Amount

In-State Incorporation?*

No Yes

In-State Incorporation:*

Processing Fee

Out-of-State Incorporation:*

Processing Fee

Grand Total:

Acceptance of Fees:*

I approve payment above.

Certificate of Disclosure

Has any person (a) who is currently an officer, director, trustee,  shareholder, or (b) who controls or holds over twenty per cent of  the issued and outstanding common shares or twenty per cent of  any other proprietary, beneficial or membership interest in the  corporation, served in any such capacity or held a twenty percent interest in any other corporation (not the one filing this Certificate) on the bankruptcy or receivership of the other corporation?

Bankruptcy Other Corporation?*

No Yes

Has any person (a) who is currently an officer, director, trustee, or incorporator, or (b) who controls or holds over ten percent of the issued and outstanding common shares or ten percent of any other proprietary, beneficial or membership interest in the corporation been: Convicted of a felony involving a transaction in securities, consumer fraud or antitrust in any state or federal jurisdiction within the five-year period immediately preceding the signing of this certificate?

Felony Other Corporation?*

No Yes

Signatures

1st Officer`s Signature:*

Date:

2nd Officer`s Signature*

Date:

3rd Officer`s Signature:*

Date:

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