Information Packet

Thank you for your interest in our services. In order to serve you better, please fill out the form below including payment information for the applicable fee or send a check. You may download the form here if you would rather print it and fax it to us, however, no filing will be done until full payment is received. We currently accept payment via check, wire transfer*, United States Postal money order, American Express, Visa, or Mastercard. Please do not hesitate to contact us if you have any questions.

You will find several plan packages from which to choose. Unless otherwise stated, included in each package is our inital fee for us to act as your registered agent for the current year. Each year thereafter, you will be billed our annual registered agent fee.

If you are preparing and filing the necessary documents with the Delaware Secretary of State and only require registered agent services, our current annual registered agent fee is $75.00** for companies with United States mailing addresses and $100.00 (USD)** for companies with mailing addresses outside the United States. (Due to the increasing rates of the postal and courier services, we were forced to raise our rates for these clients). The annual registered agent fee is non-refundable and is not pro-rated for any reason. If you officially close your company with the State of Delaware, registered agents fees will no longer be required. If you do not file a cancellation or dissolution with the State of Delaware you will be required to pay the registered agent fees until the company goes void with the State of Delaware. We require that if you are no longer doing business that you file a cancellation or dissolution of the company with the State of Delaware.

As your registered agent, our duty is to forward any mail received from the Secretary of State promptly to you. This includes your State of Delaware annual tax notice and any delinquency notices. We also accept service of process for legal filings required to be served upon your company at our address. Our annual registered agent fees do not include use of our address for other company, financial, state and governmental purposes.

Please let us know if you have any questions or if we can be of further service.

*Additional wire transfer fees apply.
**Prices subject to change without prior notice.


Instructions:

Please provide us with your basic information in Section A. If we are to form a Corporation, LLC, or LP, please fill out the appropriate section (Corporations - Section B, LLC - Section C, LP - Section D). If we are to assist in obtaining the Taxpayer Identification Number for your company, please fill out Section E.
Plan *
 Platinum 
 Gold 
 Silver 
 Bronze 
 Registered Agent Only 
Filing Service *
 Regular (non-priority, no extra fees) 
 Expedited - same day (additional fees apply) 
 Expedited - 24 hour (additional fees apply) 

A. Entity Information

Type: *
 Corporation 
 Limited Liability Company 
 Series LLC 
 Limited Partnership 

Exact Name of Entity desired:

Entity Name Choice 1: *
Entity Name Choice 2:
Entity Name Choice 3:

Please send all correspondence for this entity to (contact person):

Name *

First

Last
Address *

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone *

###
-
###
-
####
Email *

I certify that Delaware Registered Agents & Incorporators, LLC. nor any of its employees or agents have provided me with any legal and/or financial counsel and/or advice.

(We can not proceed with your entity formation without your signature.)
Signature *
Date *

MM
/
DD
/
YYYY

I authorize Delaware Registered Agents & Incorporators, LLC. to charge my credit card (or check enclosed).

Payment Type
 Visa 
 MasterCard 
 American Express 
 Check 
Card Number
Expiration Date
MM/YY
Security Code
3 or 4 digits
Name on Card
Billing Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone # Assoc. with Card

###
-
###
-
####
Signature
Amount
$
Dollars
.
Cents

B. Corporations

If we are to form your corporation, please fill out the applicable information in Section B. Please note—our customary corporation has 1000 shares at $.01 par value. If you require a different capital structure, please contact us to discuss the additional fees involved.

1. Stock
Class of Stock 1
i.e. Preferred/Common
Class of Stock 2
i.e. Preferred/Common
Number of Authorized Shares 1
Number of Authorized Shares 2
Par Value 1
$
Dollars
.
Cents
Par Value 2
$
Dollars
.
Cents

2. Principal Place of Business (Outside of Delaware):
Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

3. Directors/Officers/Bylaws (Silver, Gold & Platinum Packages only):

This information will NOT appear on the Certificate of Incorporation)

i. Directors:
Number of Directors
Director Name 1
Director Name 2
Director Name 3

ii. Names of Officer(s):
(One person may hold all offices in Delaware)
President
Vice-President
Secretary
Treasurer

iii. Officer(s) to sign checks:
(Please check all that apply)
 President 
 Treasurer 
 Secretary 
Number of Signatures required on checks
 One 
 Two 
 Three 

iv. Shareholders
Shareholder Name 1
Shareholder Name 2
Shareholder Name 3
Par Value 1
Par Value 2
Par Value 3
# of Shares 1
# of Shares 2
# of Shares 3
Capital Consideration 1
Capital Consideration 2
Capital Consideration 3

4. Form 2553 - S-Election (Corporations Only).

If an "S" election for the corporation under federal income tax law is requested, a discussion of certain detailed considerations involving the election itself should take place with our counsel, David I. Walsh Esquire, P.A. or your own attorney or accountant. The following information is required for us to complete your form.

Name, Social Security Number and amount of stock for each stockholder:
Stockholder 1 Name
Stockholder 2 Name
Stockholder 3 Name
Stockholder 1 Address
Stockholder 2 Address
Stockholder 3 Address
Stockholder 1 Social Security #
Stockholder 2 Social Security #
Stockholder 3 Social Security #
Stockholder 1 Amount of Stock
Stockholder 2 Amount of Stock
Stockholder 3 Amount of Stock