Corporate Order Form

Gerald Weinberg, P.C.
email: corps@weinbergpc.com
90 State Street - Suite 815
Albany, NY 12207 USA
Voice: 800-342-9856
Fax: 800-354-3381


If you have any questions in completing this form, please contact us.

Your Name....................
Firm Name.....................
Firm Address Line1........
Firm Address Line2........
Firm Address Line3........
Firm Telephone Number.

Proposed Name #1........
Proposed Name #2........
Proposed Name #3........
Have These Names Been Checked For Availability?...................... YES NO


County.................................................................................
Stock...................................................................................
Service of Process/Registered Agent Name and Address1....
Service of Process/Registered Agent Name and Address2....
Service of Process/Registered Agent Name and Address3....
Purpose .........................................
Purpose .........................................
Purpose .........................................
Other ............................................


Directors Name and Address1......
Directors Name and Address2......
Officers Name and Address1........
Officers Name and Address2........
Fiscal Year End.............................

Payment Information

Check:
A Check in the amount of $ is enclosed.

Credit Card: Warning!! - Mailing Credit Card Information via Internet Mail is NOT SECURE!
Name of Credit Card................:
Name appearing on Card...........:
Credit Card Number..................:
Expiration Date..........................:


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