Auxiliary Registered Agent Order Form September 25, 2016by Incserv Page 1 of 3 - This is a 3 page form. You are on page 1 of 3 General Order Form If you need assistance placing an order or prefer to simply email your request, you may contact us at 800.346.4646, 302.531.0855 or by email to info@incserv.com * Indicates a required field Annual Report ServicesLearn More About Our Annual Report Services Include Annual Report Filing Service (ARFS) Include Annual Report Monitoring Service (ARMS) Can you tell me more about this service and why it would be helpful? I'm not interested. Mail Forwarding ServiceLearn More About Our Mail Forwarding Service Mail Forwarding – Standard Mail Forwarding – Premium Electronic Mail Forwarding – Standard Electronic Mail Forwarding – Premium Electronic Mail Forwarding – Premium Plus Can you tell me more about this service and why it would be helpful? I'm not interested. Virtual Office ServiceLearn More About Our Virtual Office Service Delaware Virtual Office Address Washington, DC Office Address Can you tell me more about this service and why it would be helpful? I'm not interested. Employer Identification Number (EIN)Learn More About Employer Identification Number (EIN) Include Employer Identification Number (EIN) Corporate Minute Book Economy Standard Deluxe Additional Seal Include Additional Seal Additional Stock Certificates Include Additional Stock Certificates Entity Name* In This Jurisdiction*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 Special Instructions Expedite if Available Please Expedite My Order if Available If You Are Working With a Specific CSR or Office, Please List Here Please Provide Your Contact and Billing Details Below Contact Name* Company Name Shipping Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country Afghanistan Albania Algeria American Samoa Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faroe Islands Fiji Finland France French Polynesia Gabon Gambia Georgia Germany Ghana Greece Greenland Grenada Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Saint Martin Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Sudan, South Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Yemen Zambia Zimbabwe Phone* If Billing Contact Name Differs, Please Enter Here Billing Reference # Billing Address* Check If Billing Address is Same as Shipping Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country Afghanistan Albania Algeria American Samoa Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faroe Islands Fiji Finland France French Polynesia Gabon Gambia Georgia Germany Ghana Greece Greenland Grenada Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Saint Martin Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Sudan, South Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Yemen Zambia Zimbabwe Email* Shipping Method*Email First Class Overnight Intended Payment Method*Credit Card ACH Bank Transfer Certified Check/Money Order Wire Transfer Bill My Account Please mail your payment to: Incorporating Services, Ltd. 3500 S DuPont Hwy Dover, DE 19901 The following information is required to wire funds to our bank: BANK NAME: The First National Bank of Wyoming BANK ADDRESS: 120 W. Camden-Wyoming Avenue Wyoming, DE 19934 BANK PHONE NUMBER: 302-697-2666 BANK ACCOUNT NAME: Incorporating Services, Ltd. BANK ACCOUNT NUMBER: 0188495201 BANK ROUTE NUMBER: 031100636 Please request on ALL wires that our bank email/fax us upon receipt of the funds and include a clear reference on the wire as to what it is payment for (i.e. invoice number, client number). In addition, please be aware that some banks charge a fee for wiring funds. IncServ’s bank charges a $10.00 fee for receiving and processing wired funds. BE SURE TO INCLUDE THIS ADDITIONAL $10.00 TO THE AMOUNT OF THE WIRE. Please check with your bank when initiating the wire transfer. As they charge a fee or if a corresponding bank is used, they may also charge a fee; it is your responsibility to pay it so the wire we receive is for the full amount required. Further, if you are wiring funds from outside of the United States, please be sure to check with your bank if there will be a difference in the currency between your country and the United States. The wire received by our bank MUST be for the proper amount in order to clear your account in full. Incserv makes every effort to ensure that wired and trust account monies are applied accurately and correctly. Every client is entitled to a refund for unused monies, and Incserv actively informs all clients of unused monies. Open credits/unused monies on accounts with no activity after 18 months are subject to a $30 monthly service charge. Incserv Account # How Did You Hear About Us?If this is your first order with Incserv, please indicate how you heard about us. Reference Number CAPTCHA {all_fields} Click the button below to submit your request to Incserv. A Client Services Representative will contact you with a quote and payment instructions. Response times are between 30-60 minutes during regular business hours. By clicking "Submit " I agree to receive emails, text messages, and phone calls. Consent is not a condition of purchase. Msg & data rates may apply. Message frequency varies. Unsubscribe at any time by replying STOP. Δ