Your Name:

Your Email:

Phone#

1. Possible corporate names
(List 3 names in order of priority):

A.

B.

C.

2. Initial agent for Service of Process
(i.e. contact person for official matters):

Name

Address

3. Number of shares of common stock to be issued
(traditionally 1,000,000 shares):

4. Board of Directors / 1-4 persons.
(Single owner corporations typically have only one.):

Full Name A.

Address A.

Full Name B.

Address B.

Full Name C.

Address C.

Full Name D.

Address D.

5. Shareholders' information, consideration refers to either, i.e. either (i) money paid, (ii) property contributed, or (iii) the value of prior uncompensated services rendered to the Corporation in exchange for stock):

Name

Address

Social Security #

Ownership %

Consideration

Name

Address

Social Security #

Ownership %

Consideration

Name

Address

Social Security #

Ownership %

Consideration

Name

Address

Social Security #

Ownership %

Consideration

6. Officers (full name and address):

President

Address

Vice President

Address

Secretary

Address

Treasurer

Address

7. For Subchapter "S" corporations ONLY, provide the following spousal information:

Spouse #1

Address

Social Security #

Spouse #2

Address

Social Security #

Spouse #3

Address

Social Security #

Spouse #4

Address

Social Security #

8. Mailing address of principal executive office
(P.O. Box not allowed) for public records:

Address

9. List the Corporation's banks and authorized signatories (acting alone or in combination):

Signatories:

10. Accounting year CalendarFiscal(for S Corporations only a Calendar year is permitted.)

11. Accountant's information:

Name

Address

Phone#

12. If the Corporation is outgrowth or continuation of a predecessor, please list the name of predecessor, type of organization and period of existence:

Name

Type

Period

13. Provide a one line summary description detailing the nature of your business:

14. List the first date when you first expect to pay employees of the new Corporation: Format is YYYY-MM-DD

15. List the maximum number of employees you anticipate having during the first year of business:

Notes/Comments: