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International Incorporation Order Form
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Name: ___________________________________________________________
Address: ___________________________________________________________
City, State, Zip: ___________________________________________________________
Country: ___________________________________________________________
Telephone: ___________________________________________________________
Best Hours to Call: ___________________________________________________________
Fax: ___________________________________________________________
(Please include country and city codes)
¨
I instruct CRA to incorporate a _____________________________________, (type of company) immediately in _____________________________ (name of country). This includes the first year registered office and registered agent fee. Please deliver all documents and share certificates to my attention at the above address enclosed is $_____________.

My choices of company names in order of preference are:

First Choice _________________________________________________________
Second Choice _________________________________________________________
Third Choice _________________________________________________________
¨ Bearer Shares; or
¨ Registered Shares
_________________________________________________________
Shareholder Name(s), if registered
¨ NOMINEE DIRECTORS.First year. (optional if available) $_____________
¨ NOMINEE SHAREHOLDERS. First year. (optional if available) $_____________
¨ CORPORATE CURRENT (CHECKING) ACCOUNT $_____________
¨ SECURITIES TRADING ACCOUNT $_____________
 

ADDITIONAL SERVICES. (if any):
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

$_____________
TOTAL  $_____________

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