Fill and Sign the Business Incorporation Form

Incorporation Questionnaire General Information Proposed Name: Alternate corporate names if your first choice is not available (in order of preference): 1. 2. 3. Principal business address of proposed corporation: Mailing address of proposed corporation: Address of the registered office of the corporation (cannot be a P.O. Box): What will be the activities of your proposed corporation? Will the corporation will be buying goods from a wholesaler and reselling them? Yes No Is this business already a going concern? Yes No If yes, did you start the business or did you acquired a business? Starting date of the business or the date of your acquisition: Did you hire any employees? Yes No If yes, when? Trade name of the proposed corporation (if applicable): Is there more than one place of business? Yes No If yes, list locations: Target date of incorporation: Fiscal year end: Name of its registered agent, (if any): Agent’s address: Name and address of each incorporator (list at least one). Incorporator One: Incorporator Two: Capitalization Number of shares issued and outstanding: The aggregate number of shares that the corporation has authority to issue. The corporation will authorize voting shares nonvoting shares voting and nonvoting shares. Class of shares: Par value: If more than one class of shares list classes. Common Attributes: Class A Attributes: Class B Attributes: Other (specify): Attributes: Shares owned by initial shareholders: Name Number of Shares Consideration Given in Exchange for Shares Will the shareholders be entering into a Buy and Sell Agreement? Yes No Executive Members Person(s) to serve on the first Board of Directors (one or more). Director One: Director Two: Director Three: Person(s) to serve as the first Officers (one or more). President: Address: Social Security Number: Chief Executive Officer: Address: Social Security Number: Chief Financial Officer: Address: Social Security Number: Secretary: Address: Social Security Number: Treasurer: Address: Social Security Number: Other: Address: Social Security Number: Other members: Member Rights Privileges Qualifications Duties Manner of Election/Appointment Voting Rights Miscellaneous Corporation’s accountant: Name: Address: Telephone: Would you like the accountant or our firm to request the corporation’s federal tax identification number from the I.R.S.? Highest number of employees expected in the next 12 months? Estimated first date that wages will be paid? Do you want the corporation to be taxed as an S-Corporation? Yes No Name, address, and phone number of bank which will handle the accounts of proposed corporation: Has this account been opened yet? Name of signatory(ies) to corporate checking account: Have you ever previously applied (signed the application) for an employer identification number "EIN"? Yes No If yes, state the name of the applicant: , approximate date of the application: , location where the application was filed (city and state): and the previous EIN: Does the proposed corporation have a foreign affiliate with a similar name? Yes No If yes, what is the name of the affiliate?: Where are corporate records to be kept?: Corporation Our firm Annual resolutions are to be prepared by: Corporation Our firm Is a company seal to be ordered? Yes No List all related corporations: Do the owners of the corporation require a professional license such as a Physician, Attorney, Accountant, Realtor, Veterinarian, Chiropractor, etc. to run the corporation? Yes No