Type of Organization
Corporation  Limited Liability  Not-For-Profit  Professional  Close
State of Incorporation:	Please choose a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming British Virgin Islands Canada Cayman Islands Commonwealth of the Marian Islands Guam Panama Puerto Rico Northern Marian Islands US Virgin Islands
Year or Full Date:	(Full date only for California or Hawaii)
Name of Incorporation:
	All capital letters     Upper and lower case

Number of Authorized Shares

(1)   Par Value:  Undesignated:

(2)   Par Value:  Undesignated:

Multiple classes of stock

Reflecting               Non-Reflecting   (To be used only when you have multiple classes of stock.)

Stock Designations
Common              Preferred           Undesignated
Certificates signed by
President              Secretary           Treasurer
Secretary/Treasurer   Vice President   Other
Other Signature Name
Shipping
Airborne AM   Airborne 2nd Day   Airborne SDS   UPS    RPS
Clauses
Standard Clause	Designation clause for multiple classes of stock
Delaware clause for multiple classes of stock	Securities Act of 1933
California Section 25102F & H and 418C	Special (Please e-mail or fax to us)

Billed To:
Reference # :
Customer # :
	(if you don't have a Customer number, please include a credit card number)
Firm Name:
Street:
City:
State:	Please choose a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming British Virgin Islands Canada Cayman Islands Commonwealth of the Marian Islands Guam Panama Puerto Rico Northern Marian Islands US Virgin Islands  Zip:
Attention:	Title:
Telephone:	(important to contact you if we have a question)
Email:
Ship To:
	Same as Billed To
Firm Name:
Street:
City:
State:	Please choose a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming British Virgin Islands Canada Cayman Islands Commonwealth of the Marian Islands Guam Panama Puerto Rico Northern Marian Islands US Virgin Islands  Zip:
Attention:
Telephone:
Payment:
Credit Card Type:	Please choose card type Master Card VISA AMEX
Card Number:	Valid Thru: mm/yy
Name On Card:
Comments: