Nonprofit Corporation

Contact Information

Name

First Last

Email*

Enter Email Confirm Email

Phone*

1. Corporation 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

1st Choice

2nd Choice

3rd Choice

2. This corporation is a: (Check one appropriate category. You may refer to W.S. 17-19-1804 for definitions of these terms.)

Religious
Public Benefit
Mutual Benefit

3. Name and physical address of its registered agent:

Name

Address

PO Box is acceptable if listed in addition to a physical address.

Street Address City State / Province / Region ZIP / Postal Code

4. Mailing address of the nonprofit corporation:

Street Address City State / Province / Region ZIP / Postal Code

5. Principal office address:

Street Address City State / Province / Region ZIP / Postal Code

6. This corporation

will have
will not have members.

7. Provisions regarding the distribution of assets upon dissolution are:

(How will the assets be distributed if the nonprofit corporation is dissolved?)

8. The type of business the nonprofit corporation will be conducting:

9. Name and address of each incorporator

Name	Address

10. Certification. (Please check the box to complete the required certification.)

I consent on behalf of the business entity to accept electronic service of process at the required email address provided on the form under the circumstances specified in W.S. 17-28-104(e).

11. Execution (all incorporators must sign):

Print Name	Date

Contact Person:

Daytime Phone Number:

Email

Consent to Appointment by Registered Agent

Name of Registered Agent

First Last

Registered office is located at:

Street Address Address Line 2 City State ZIP Code

Name of Business Entity

Daytime Phone

Email

Registered Agent Mailing Address (if different)

Street Address Address Line 2 City State ZIP Code

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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