NATIONAL INCORPORATION
CENTER
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.
Payment Method:
I will pay for my paperwork by:
Credit Card (information below)
Mailing In My Check, Money Order or Cashier's CheckReturn 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
VISACredit Card Number
Expiration DateCard 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) 692-1768
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