Form 080107 - Application For Incorporation Of A Nevada Ic-Disc
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1
2For Office Use Only
STD
SPEC
COM SER B/S
FISC
APPLICATION FOR INCORPORATION
OF A NEVADA IC-DISC
Please complete the following and return it to Export Assist at 44 Montgomery Street, Suite 4050, San
Francisco, CA 94104 (T:800-894-8366). Additional information may be included on an attached sheet.
U.S. EXPORTER INFORMATION
Name: __________________________________________________ Title: _____________________________
Company: _______________________________________________ Phone: ___________________________
Address: ________________________________________________ Fax: ______________________________
City, State, Zip: ___________________________________________ E-mail: ____________________________
Do you wish Export Assist to work with your outside professional advisor? Yes ____ No ____
If yes, please complete the following:
CPA ____
Attorney ____
Name: __________________________________________________ Title: __________________________
Company: _______________________________________________ Phone:_________________________
Address: ________________________________________________ Fax: ___________________________
City, State, Zip: __________________________________________ E-mail: _________________________
1)
Description of export business activity:__________________________________________________________
Primary countries to which you export: _________________________________________________________
2)
Ownership: Publicly-traded ____
Privately-held ____; if privately-held, total number of owners: _________
3)
Structure: C Corp ____
S Corp ____
LLC ____
Partnership ____
Sole Owner _____ Co-Op _____
State of incorporation or organization: _______________________
4)
Date of fiscal year end: ______________________
5)
Are the members of this owners’ group currently operating or have in existence an Interest Charge Domestic
International Sales Corporation (IC-DISC)? Yes ____
No ____
6)
Are there any individual or corporate foreign shareholders? Yes ____
No ____
If yes, how many? ______ Percent of ownership for each: _____________________________________
7)
Do you import components for your export products? Yes ____ No ____ ; if yes, ____% of total export sales.
8)
IRS Service Center (city and state) where exporter files its Federal income tax return: _____________________
9) Shareholder name(s), permanent residence address and percentage of interest:
Name:_____________________________________________________________ % of Interest: ____________
Address: __________________________________________________________________________________
Name:_____________________________________________________________ % of Interest: ____________
Address: __________________________________________________________________________________
Name:_____________________________________________________________ % of Interest: ____________
Address: __________________________________________________________________________________
080107
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