CORPORATE INFORMATION FORM

Name of Incorporation
Alternate Name(s)
Nature of Business
Type of Incorporation
State of Incorporation

Names and Addresses of Directors: (Only one required in some states)

NAME(S) OF OFFICERS (Some states allow one person to hold all offices)

President		Vice President
Secretary		Treasurer

Number of shares of stock

Par Value $

(We will automatically form your corporation with the minimum number
of shares at no par value to qualify for the lowest state fees, unless
you specify otherwise)

Mailing Address for billing, tax reports, and service of process

Name
Street Address
City	State Zip
Email Address
Telephone
Fax

FEE WORKSHEET

State Service Fee
LLC State Service Fee
FEDERAL TAX ID NUMBER*
Application for subchapter S corporation status *
Corporate Kit
Washington, DC Headquarters and Mail Forwarding Service
TOTAL DUE TO CORPORATE EXTENSIONS

I hereby authorize Corporate Extensions, Inc. to serve as my incorporator
and certify that neither Corporate Extensions, Inc. nor any of its agents
or employees have provided me with any legal or financial counsel.

If you do not wish to submit this form on-line, you may print it out and then clear it, after which you may mail or fax it to our Washington, DC offices. Or you can call us toll free at (800) 474-6340 and we can incorporate you over the phone.

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