CONFIDENTIAL INFORMATION FORM - 
After Pressing the Submit Button You Will Be Taken To The Secure Credit Card Application   

Your Name

Name of Registered Company

File Number

Your Billing Address

City, State, Zip Country

Telephone No.    Fax No. 

Email Address

Authorized Signatory:   Dated:  

Send Confirmation of Receipt of Form to me at     (your e-mail address)

DISCLAIMER:  Please check here to verify that you have read the following Disclaimer.

I  do hereby certify that Global Corporate Services, Inc. has not provided me with personal counsel or tax advice. I, (or on behalf of my client) do guarantee payment of the yearly resident agent fee of $90.00 payable to Global Corporate Services, Inc. due January 15th of every calendar year and acknowledge that the franchise tax is due to the State of Delaware prior to March 1st of every year if a corporation and June 1 for an LLC.                                                               

Corporate Office and Address for the Corporation or LLC
 103 Fowler Court
New Castle, DE 19720