NATIONAL INCORPORATION CENTER

Now In Our 20th Year

doityourselflegalforms@divorcehelp.net Phone: (940) 343-8169

Confidential Information Form

 1. Name of corporation (must have a corporate ending such as
"incorporated", "inc.", "Corporation", "Corp." or "Company"):
    
    ________________________________________________________
 
    (a) Alternate name if above name is reserved or already
    being used by another corporation:
 
    ________________________________________________________
 
 2. Nature of business the company will transact:
 
    ________________________________________________________
 
 3. State of incorporation:
 
    ________________________________________________________
 
    Qualify to do business in:
 
    ________________________________________________________
 
 4. Type of corporation: (check either)

    ____ Open  or  ____ Closed    

 5. Number of shares of common stock (  1,000 Shares will be 
designated with NO-PAR VALUE unless otherwise 
    specified.)

    ________________

 6. Principal office outside state of incorporation:

    ________________________________________________________

 7. Number of Directors:

    ________________

 8. Name(s) of Director(s): 

    ________________________________________________________

 9. Names of officer(s): 

    President ______________________________________________

    Secretary ______________________________________________

    Vice President _________________________________________

    Treasurer ______________________________________________

10. Any special instructions:

    ________________________________________________________

11. Person designated to receive any correspondence or legal
     service for the corporation:
    
    Name: __________________________________________________

    Address: _______________________________________________

    City: __________________________________________________
    
    State: ______________  Zip: ______________

    Daytime Telephone: _____________________________________

    Fax Number: ____________________________________________ 
    




    

Select the format for file transfer below. 
 Leave in Word Perfect 6.0 (.wpd)Adobe (.pdf)Rich Text Format RTF(*.rtf)
Payment Method: 
I will pay for my paperwork by:
 Credit Card (information below) 
 Mailing In My Check, Money Order or Cashier's Check
Return mail my signature ready paperwork by:
 e-mail attachment to the following e-mail address:
 
Overnight Express Shipping (Charged to your credit card directly by Fed Ex - no surcharge)
Priority US Postal Shipping [2-3 day delivery] ($5 surcharge)
1st Class U.S. Postal to the above mailing address. [no additional surcharge] 
Credit Card Account Information
For payment by credit card, please complete the information below. This will enable us to begin processing your paperwork immediately. 
Checking Account Debit Card (MasterCard & Visa only)
*You may use your MasterCard or Visa checking Account Debit Card by completing the following credit card information. This will allow your checking account to be debited and processing to be done immediately. 
Which Credit Card Will You Be Using?
 MasterCard 
 VISA 
Credit Card Number
 Expiration Date
Card Holder's Name (as it appears on the card)
Street Address (As it appears on the card)
City/State (As it appears on the card)
 Zip code [As it appears on the card]
Charge my credit card in the amount of: 
NON-TEXAS RESIDENTS
$149 [*includes delivery by e-mail or 1st Class US Postal]
$154.00 Priority Mail USP Shipping [2-3 day delivery]($149 + $5 surcharge) 
$149.00 Overnight FedExpress Shipping (Fed Ex Charges billed by Fed Ex - no surcharge)

TEXAS RESIDENTS: [Includes TX state sales tax of $12.29 included below]
 $161.30 [*includes delivery by e-mail or 1st Class US Postal]
 $166.30 Priority Shipping [2-3 day delivery]($161.30 + $5 surcharge) 
 $161.30 Overnight FedExpress (Fed Ex Charges billed by Fed Ex - no surcharge)

You may also 'call in' your credit card account information to (940) 692-1768.
      I am authorizing the charge to my credit card for the purchase I have made above, the same as if I had personally signed a credit card purchase/payment receipt; and I will be responsible for all collection fees, and any other costs associated with the collection of my payment, should it become necessary. 
I certify that neither the National $149 Incorporation Center or
any of its employees or agents have provided me with any personal
counsel or advice.

    Signature X ____________________________________________

    Date: ____ / ____ / ____

     
      
    

    

       

    

    

    

     

    

     

     

     

      

     

   

    

        
        
    
     

     

     
    
        

      

      

         
           
  

      

         

          
            
         
        

                  National Divorce & Bankruptcy Center
                 3037 F Cunningham Dr

                  Wichita Falls,
                  Texas 76308
                  (940) 337-4129

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