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CORPORATE ACCOUNTS
FORM A CORPORATION

Account Information

Account / Firm Name:

Order Placed By:

Reference # (optional):

General Information

State of Formation:

Entity Name:

(Please list two options to ensure availability)

List names exactly as they should appear,
including name ending (i.e. Inc. Corp. Ltd.)

Agent Information (Not required for NY state)

Registered Agent Name:

Street Address:

I have no agent. Please provide a registered agent for this entity.

Entity Address

Mailing Address:

County:

Shares

Number of Shares :

Par Value:

If unspecified, entity will be formed with standard amount of shares.

Director Information (optional)

Director Name:

Director Address:

Corporate Supplies (optional)

Kit and Seal
Seal

Corporation Information

Please provide a Tax ID number for this entity

Name of President:

Social Security Number:

Principal Business Activity:

Business Type:

C-Corporation
S-Corporation

S Corp (optional)

Please prepare forms for Sub-chapter S election.

Shareholder Name:

Social Security #:

Address:

Percentage of shares:

Special Instructions

Please include any special instructions in this text area.

Questions About this Order

An incorporation specialist will review your order
and contact you, if necessary, at:

ext.

A detailed order confirmation will be sent to you @:

To speak with a live representative about this order please call 845-425-0077.

Carefully review the information entered then click submit.

"Our experience with incorporating our company was flawless and pleasant"

Thanks,
Jaime Frand - N.J.

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