PA-Basic Incorporation Service - M. BURR KEIM COMPANY

Please furnish us with the following information to organize a Pennsylvania Corporation.

Contact Information

Firm Name

Attention

Phone

Address

Street Address City State ZIP Code

Entity Information

Corporation Type

Business Corporation

Professional Service Corporation

Proposed Name

2nd Choice

3rd Choice

Brief Statement of Purpose (required for docketing statement)

Share Information

Number of Authorized Shares

Par Value

No Par Value

Incorporator Name and Address

Incorporator

M. Burr Keim Company to sign as incorporator

Incorporator Name

Incorporator Address

Street Address Address Line 2 City State ZIP Code

Registered Agent Information

Registered Agent

M. Burr Keim Company to Provide

We can provide the required registered office service for an annual fee of $139.

Registered Agent Name

Registered Office Address

Street Address Address Line 2 City State ZIP Code

Name and address of individual person to receive correspondence & tax reports. (May be any address)

Tax Report Individual Name

Tax Report Individual Mailing Address

Street Address Address Line 2 City State ZIP Code

Fiscal Year Ending (Last Day of)

Federal Employer Identification Number (FEIN)

Please complete the following section if you would like M. BURR KEIM COMPANY to obtain the FEIN.

FEIN - Legal name of the responsible person

Social Security Number

FEIN - Mailing Address

Street Address City State ZIP Code

FEIN - Phone

FEIN - Type of Corporation

C Corporation

S Corporation

Does the entity have/expect to have employees who will receive forms W-2 in the next 12 months?

Yes

Does the entity expect to pay less than $5,000 in total wages during the next calendar year?

Yes

When does the entity expect to begin paying wages (mm/yr)?

Pricing Information

The estimated costs are as follows:

Pennsylvania State Filing Fee	$125.00
Checking Availability of Name	$10.00
M. BURR KEIM COMPANY Service Fee	$145.00
Legal Publication Costs	See below chart
Obtain FEIN	$55.00
Corporation Outfit	$100.98

Legal Publication Costs (estimated)

Allegheny County	$175.00
Philadelphia County	$276.00
Montgomery County	$165.00
Bucks County	$140.00
Chester County	$145.00
Delaware County	$200.00
**Please contact our office for an estimate if your county is not listed.

Special Instructions

Expedite

Submit on same-day filing basis - add $155.00

PA Filings are taking an estimated 1 week at the Department of State. We can submit a same-day filing by the next business day and send the filed copy to you as soon as it is available.

This field is for validation purposes and should be left unchanged.

Pennsylvania

ONLINE WORKSHEET FOR ORGANIZING A PENNSYLVANIA CORPORATION

Please furnish us with the following information to organize a Pennsylvania Corporation.

Contact Information

Entity Information

Share Information

Incorporator Name and Address

Registered Agent Information

Name and address of individual person to receive correspondence & tax reports. (May be any address)

Federal Employer Identification Number (FEIN)

Pricing Information

Legal Publication Costs (estimated)