IncParadise.com - payment credit card

Registered Agent service for one year ___ $89. Company Name__________________

Additional years of resident agent (pre-pay special) ___ $40 for 2nd year ___ $40 for 3rd year	Annual list of Officers and Directors ___ $125 + $10 processing fee for regular filing ___$200 + $10 processing fee for expedite filing
Add Corporate kit ___ $30 + $20 shipping (without seal) ___ $35 + $20 shipping (embossing seal)	Nominee director/officer: ___ $250 Nominee EIN (tax ID): ___ $250
Certificate of Good Standing ___ $70 regular filing (2-3 weeks) ___ $120 expedite filing (24 hours)	Add Mail forwarding: ___ $129 ($99 per year + $30 postage) ___ $180 ($150 per year + $30 postage) ___ $280 ($250 + $30 postage)
TOTAL:	.

PAYMENT INFORMATION: I authorize Eastbiz.com, Inc. to debit my credit card.

Check one:	__ VISA __MasterCard __ Discover __ AMEX
Credit Card Number:
Expiration Date:
Name on the card:
Billing address:
City and State	City State ZIP code

Signature Of Card Holder______________________________ (Signature is required)

CONTACT INFORMATION

Company name

Contact Name

Phone, fax Phone: Fax:

Email:

Mailing address:

City and State City State ZIP code

Please fax to (866) 838-0363 or (702) 387-3827, EastBiz.com, Inc.– Nevada Corporations
Phone: (702) 871-8678, www.incparadise.com, info@incparadise.com

Company name
Contact Name
Phone, fax	Phone: Fax:
Email:
Mailing address:
City and State	City State ZIP code