Incorporation Request

For use as attorney-client work product only.
Today's Date:
Client Name:
Name of Corporation:
Alternate Names (List two other names in case your first preference is already taken.):
Corporate Street Address:
Corporate Mailing Address:
Telephone Number:
Fax Number:
Business Purpose of Corporation:
Registered Agent Name:
Registered Agent's Address: Same as corporate street address or:
Gwinnett County OR:
Professional Corporation?Yes No
Nonprofit Corporation?Yes No

Corporate Officers:
President:
Vice President:
Secretary:
Treasurer:

Corporate Directors:
NameResidence AddressSocial Security Number

Corporate Shareholders:
NameNo. of SharesAmount Paid for Shares*Social Security Number
Number of Authorized Shares:10,000
Par Value:$1.00
Corporate Bank:
Fiscal Year End**:December OR
S Election:Yes No
Number of Employees:
Date of First Payroll:,
Name of CPA:
Is CPA filing SS-4 (Application for Federal Employer Identification Number) and S Election Form?Yes No


* Should be at least number of shares purchased X par value.

** Usually, a professional corporation or an S corporation MUST have a December fiscal year.