Incorporation Intake Form

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    Your Name:

    Your Email:

    Phone#

    1. Possible corporate names
    (List 3 names in order of priority):

    A.

    B.

    C.

    2. Initial agent for Service of Process
    (i.e. contact person for official matters):

    Name

    Address

    3. Number of shares of common stock to be issued
    (traditionally 1,000,000 shares):

    4. Board of Directors / 1-4 persons.
    (Single owner corporations typically have only one.):

    Full Name A.

    Address A.

    Full Name B.

    Address B.

    Full Name C.

    Address C.

    Full Name D.

    Address D.

    5. Shareholders' information, consideration refers to either, i.e. either (i) money paid, (ii) property contributed, or (iii) the value of prior uncompensated services rendered to the Corporation in exchange for stock):

    Name

    Address

    Social Security #

    Ownership %

    Consideration

    Name

    Address

    Social Security #

    Ownership %

    Consideration

    Name

    Address

    Social Security #

    Ownership %

    Consideration

    Name

    Address

    Social Security #

    Ownership %

    Consideration

    6. Officers (full name and address):

    President

    Address

    Vice President

    Address

    Secretary

    Address

    Treasurer

    Address

    7. For Subchapter "S" corporations ONLY, provide the following spousal information:

    Spouse #1

    Address

    Social Security #

    Spouse #2

    Address

    Social Security #

    Spouse #3

    Address

    Social Security #

    Spouse #4

    Address

    Social Security #

    8. Mailing address of principal executive office
    (P.O. Box not allowed) for public records:

    Address

    9. List the Corporation's banks and authorized signatories (acting alone or in combination):

    Signatories:

    10. Accounting year CalendarFiscal(for S Corporations only a Calendar year is permitted.)

    11. Accountant's information:

    Name

    Address

    Phone#

    12. If the Corporation is outgrowth or continuation of a predecessor, please list the name of predecessor, type of organization and period of existence:

    Name

    Type

    Period

    13. Provide a one line summary description detailing the nature of your business:

    14. List the first date when you first expect to pay employees of the new Corporation: Format is YYYY-MM-DD

    15. List the maximum number of employees you anticipate having during the first year of business:

    Notes/Comments: