Medical Corporation - Corp Center

Corporate Name

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.
Must end with one of the following words or abbreviations: “Chartered,” “Limited,” “Ltd,” “Service Corporation” or “S.C.”

1st Choice

2nd Choice

3rd Choice

Initial Registered Agent

First Middle Last

Initial Registered Office

Street Address City State ZIP Code

Shares

Authorized Shares, Issued Shares and Consideration Received

Class	Number of Shares Authorized	Number of Shares Proposed to be Issued	Consideration to be Received Thereof ($)

Total Shares

The preferences, qualification, limitations, restrictions and special or relative rights in respect of the shares of each class are

Directors

Number of Directors constituting the initial board of directors of the corporation

Names and Addresses of persons serving as directors until the first annual meeting of shareholders or until their suc-cessors are elected and qualify

Name	Address

Estimated value of all property to be owned by the Corporation for the follow-ing year wherever located

Estimated value of the property to be located within the State of Illinois dur ing the following year

Estimated gross amount of business that will be transacted by the corpora tion during the following year

Estimated gross amount of business that will be transacted from places business in the State of Illinois during the following year

Incorporators

Name

First Last

Address

Street Address City State ZIP Code

Name

First Last

Address

Street Address City State ZIP Code

Name

First Last

Address

Street Address City State ZIP Code

Contact Information

Name

First Last

Email*

Enter Email Confirm Email

Phone*

Application Fee

Price:

Please select an additional service that you wish to have processed

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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