Name:
E-mail:
Address:
City:
State/Province:
Postal Code:
Phone:
1) Relationship with the New Business (i.e. owner, officer, employee etc)
2) The Mailing Address for the Corporate Documents (if not being picked up at our office)
3) Corporate Name to be registered (Name must include suffix such as “Corp”, “Inc.”, “Incorporated”, etc”)
4) Corporate Name to be registered (Second Choice, in case first name is not available)
5) Corporate Name to be registered (Third Choice, in case first and second name is not available)
6) Number of Corporate Stock Shares Authorized to be issued (i.e. 1,000)
7) Par Value for each share (i.e. 100)
8) Principal Address of New Business
Address:
City:
State/Province:
Postal Code:
9) Mailing Address of the New Business (if different from Principal Address)
Address:
City:
State/Province:
Postal Code:
10) Name of Registered Agent for the New Business
11) Registered Agent’s Address (P.O. Box not accepted & must be a Florida Address)
12) Please list the Names, Addresses and Title of the Initial Officer(s)/Director (s) (Only one is required, and they can be the same as the shareholders) See below for example:
John Smith, President, 1234 NW 56th Ave, Miami Florida 78910
Jane Smith, Director, 1234 NW 56th Ave, Miami Florida 78910
13) Please list the Names and Addresses of Shareholders. Also include the number of shares owned (Only one required) See below for example:
i.e. Joe Smith, 1234 NW 56th Ave, Miami Florida 78910, 500 shares of the 1000 issued
14) Please Briefly list your corporate purpose :
15) By submitting this information you hereby confirm that:
The person requesting this incorporation is fully authorized to do so
The registered agent has full knowledge of this incorporation
Both individuals grant this Firm the permission to sign the corporate documents as necessary for the filing of the same.
I understand, agree and hereby certify that the information above is correct.
Incorporate a For-Profit Company 
fee for services 