*Proposed Name:

Please select three (3) alternate names:

(1)

(2)

(3)

Physical Address of LLC (No P.O. Boxes):

Mailing Address of LLC:

Directors (Include names and addresses):

(1)

(2)

(3)

(4)

Name of Registered Agent:

Address of Registered Agent:

Stock Holders

Stock Holder 1

Name:

Home Address:

Social Security No.:

Driver's License No.:

Telephone No.:

No. of Shares:

Stock Holder 2

Name:

Home Address:

Social Security No.:

Driver's License No.:

Telephone No.:

No. of Shares:

Stock Holder 3

Name:

Home Address:

Social Security No.:

Driver's License No.:

Telephone No.:

No. of Shares:

Stock Holder 4

Name:

Home Address:

Social Security No.:

Driver's License No.:

Telephone No.:

No. of Shares:

Subchapter "S" Election:   Yes No

Type of Business:

No. of Shares/Par Value:

Costs:

Incorporation Fee: $78.75 Filing Fee ($70.00)/Certified Copy ($8.75)
Corporate Kit: $54.33 Corp. Record Book/Stock Cert./Corp. Seal
Ficititious Name: $50.00 (If applicable)
CSC Networks: $90.00 Filing fee for ASAP (not including FedEx Fee)
DOC Stamps: $0.35 Per 100 shares of issued stock
Document Prep. Fee $450.00 Preparation of all documentation
Total: $758.08