CREDIT CARD AUTHORIZATION FORM - Billing Information 
Application for
Contract of Agreement for Nominee Services
(PLEASE PRINT, COMPLETE AND FAX THIS FORM TO (703) 995-0899)

Due to the enforcement of the Patriot Act since the "911 crisis", either a SSN or a ITIN Number issued by the IRS is necessary when making an application to the IRS for the Federal Identification Number (EIN). The EIN is needed to open a Bank Account in the United States. A valid passport will NO LONGER suffice.

To apply to the IRS for the ITIN No. you must complete and process United States Form W-7 - "Application for IRS Individual Taxpayer Identification Number". Click here to download the form or connect directly to the IRS at http://www.irs.ustreas.gov. A copy of the application must accompany the Contract of Agreement for Nominee Services.

This application is needed in order to accommodate your "immediate needs" for establishing your new Corporation or LLC with a Federal ID Number. We through our nominee, can offer you Limited Nominee Services to be in existence solely for the purpose of the application for the Federal ID Number (EIN). The cost for this service is $250.00. The contract of agreement will cease upon the issuance of the ITIN Number. The contract will not go into effect without proof of the application to the IRS for the ITIN number

Click here to download the Contract of Agreement for Nominee Services.

Complete this Credit Card Application

__________________________________DOES HEREBY AUTHORIZE Global Corporate Services, Inc.
 (Name on Card)

to charge the amount of (   ) $ 250.00 for Limited Nominee Services or (   ) $750.00 for Extended Nominee Services 

 to its: (   ) Mc.gif (1385 bytes) (   ) Visa.gif (1131 bytes) (   ) Amexlogo.gif (1787 bytes) (   )

Account No. _______________________________  Expiration Date  ____________  Security Code  ___________  

Billing Address _________________________________________________________

City, State, Zip ____________________________________________ Country _____________________

Telephone No. ________________________  Fax No. ________________________

Email Address ___________________________________________

Name on Passport ___________________________ Date of Birth ___________________

Passport No. _____________________ Country Issued  ___________________ 

Date Issued _____________________ Date Expires ___________________

Signed By _______________________________  Title ________________________  Dated ______________

Provide us with the following documents:

This application must be accompanied by

Thank you for your prompt attention to this invoice. Global Corporate Services, Inc. does not provide personal counsel or tax advice. 

Please initial here (     )  that you have read this disclaimer:  "Global Corporate Services, Inc. is not responsible for any adverse reaction from the IRS in refusing to issue you an ITIN Number. This fee is non refundable."


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