Nonprofit Corporation

The name of the corporation is

Please provide 3 choices for the name, in order of preference, so in the event your preferred choice is not available we can proceed with your next choice.

Name Choice (2)

Name Choice (3)

Street Address

Initial Street Address of Corporation - Do not enter a P.O. Box City (no abbreviations) State ZIP Code

Mailing Address

Initial Mailing Address of corporation, if different than above City (no abbreviations) State Zip Code

(Enter the complete business addresses. Item 2a cannot be a P.O.Box or “in care of” an individual or entity.)

Agent is*

Individual
Corporation

California Agent's Name

First Middle Last Suffix

Agent Address

(if agent is not a corporation) - Do not enter a P.O. Box City (no abbreviations) State Zip Code

California Registered Corporate Agent’s Name

This corporation is a nonprofit public benefit corporation and is not organized for the private gain of any person. It is organized underthe Nonprofit Public Benefit Corporation Law for:

Public purposes
Charitable purposes

The specific purpose of this corporation is to

Contact Information

Name*

First Last

Email*

Enter Email Confirm Email

Phone*

Application Fee

Price:

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Priority Request / Rush Processing + $75

Total

$0.00

Consent

I agree

I CERTIFY THAT THE RECITATIONS CONCERNING THE VESSEL: NAME, TONNAGE, DIMENSIONS, PROPULSION, OWNERSHIP, HAILING PORT, RESTRICTIONS, ENTITLEMENTS, REMARKS AND ENDORSEMENTS CONTAINED IN THE CERTIFICATE OF DOCUMENTATION REMAIN ABSOLUTELY THE SAME.

NAME:*

Type your full name to sign this secure webform

Signature*

CAPACITY OF PERSON SIGNING (E.G., AGENT, TRUSTEE, GENERAL PARTNER, CORPORATE OFFICER, MEMBER)

Authorization*

I agree

I agree to pay the above total amount according to the card issuer agreement and hereby authorize the charge for the total amount above for the processing of selected applications. I understand that my application will be processed in the order in which it is received by Corporation Center, a private fee-for-service company, not owned or operated by any governmental agency. I understand that application and processing fees are non-refundable as per Corporation Center’s no refund policy.

Credit Card

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