Sample Incorporation Request Form (Non-Profit)
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1K
L
, P.C.
ISER
AW
A
L
TTORNEYS AT
AW
__________________________________________________________________________________
R
L. K
(R
.)
3915 H
R
, S
500
M
P
770-554-2480
OBERT
ISER
ET
ARRISON
OAD
UITE
AIN
HONE
R
J. K
L
, G
30052
M
F
770-554-2580
OBERT
ISER
OGANVILLE
EORGIA
AIN
AX
R
E
F
770-554-2052
EAL
STATE
AX
INCORPORATION REQUEST FORM (NON-PROFIT)
Name of Corporation
st
1
choice:
nd
2
choice:
rd
3
choice:
DIRECTOR INFORMATION
(Required for each Director)
Name:
Name:
% Ownership:
% Ownership:
Address:
Address:
Phone:
Phone:
SS#:
SS#:
CORPORATION INFORMATION
Business Address:
Business Phone:
Business Purpose / Primary Business Function:
OFFICERS
President/CEO:
Vice President:
Secretary:
Treasurer:
Federal E.I.N./Tax I.D. # (if you have it, and attach copy of SS-4):
Georgia Tax I.D. # (if you have it):
COMPLETE THIS FORM AND FAX TO ROB J. KISER AT 770-554-2580
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