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On-line Service Order 

Service Order
I would like to order: *
If "other" please specify:
In the State of:
County of:

Entity Name:

Please provide three possible names of your entity.  The first available choice will be registered. "INC" will be added to your corporate choice unless another corporate ending is provided.
First Choice: *
Second Choice:
Third Choice:


Authorized Stock & Par Value

Amount of shares:

No Par Value
Par Value of per share

Corporate Address/
Address for Process

Company Address: *
Company City: *
Company State: *
Company Zip Code: *


Purposes

Please state the company purposes:


Directors/Officers/Members/Managers

1st Name: *
1st Address: *
1st City/State/Zip: *


2nd Name:
2nd Address:
2nd City/State/Zip:
 Please choose additional services: Tax Id    $25.00 (download, sign and send SS4 with your order)   SS-4-2010.pdf
248.9 KB
 
S-election  $55.00
Overnight shipping  $30.00


Contact Information

Contact Name: *
Contact Street Address: *
Contact Suite/Room/Apt#:
Contact City: *
Contact State: *
Contact Zip Code: *
Daytime Phone: *
Fax:
Email:

Shipping Address:

No PO Boxes please
Please check the box is the same as contact
Shipping Name:
Shipping Address:
Shipping City/State/Zip Code:
Country:


Payment information:

*We cannot process your order untill payment is received
Please select a method of payment: *
Credit Card:
Card Number:
Expiration Date:
CRV:


Billing address:

Check the box if the same as contact information
Billing Name:
Billing Address:
Billing City/State/Zip Code:
Please indicate any comments
or special instructions:

*Please check for typos and make sure all information is correct
*All orders are processed to order and there will be no refunds or exchanges
*Print the copy for your records before submission

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