Corporation input

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Allan J. Weltman

Family Mediator, Florida Supreme Court Certified County Mediator, Florida Supreme Court Qualified Arbitrator

Please provide us with the information listed below so that we can complete your application for a Florida Corporation.

Name of the Corporation:

Street address of Corporation:

City, State and Zip.

Contact phone number

Number of shares of stock to be issued.

Name of the Registered Agent.

Street address of Registered Agent Same as Corp. Address

City, State and Zip of Registered Agent

Name of the Incorporator. Same as the Registered Agent

Street address of the incorporator Same as Corp. Address

City, State, Zip of Incorporator

Name of President or Principal Officer. Same as Registered Agent

Social Security Number of President or Principal Officer

List name, address, SS number and number of shares of stock of any other stockholder.

Title of Officer

Explanation of what this business does.

Number of initial employees

Have you ever applied for a Federal Tax Identification number?

If yes, list name of business, address, when filed and EIN number

Charge this to my credit card as follows:

Card Number Exp. Date

Tell us how to get in touch with you:

Please contact me as soon as possible regarding this matter.