Three proposed Corporate Names in Order of Preference:

a
b
c

d/b/a:

Physical Address of Business:

address1
address2

city state zip

Mailing Address of Business:

address1
address2

city state zip

NAMES OF OFFICERS:

President:

name

physical address

address1
address2

city state zip

mailing address, if different

address1
address2

city state zip

Vice President:

name

physical address

address1
address2

city state zip

mailing address, if different

address1
address2

city state zip

Secretary:
(President and Secretary cannot be same person)

name

physical address

address1
address2

city state zip

mailing address

address1
address2

city state zip

Treasurer:

name

physical address

address1
address2

city state zip

mailing address

address1
address2

city state zip

NAMES OF DIRECTORS:

Director #1

Name

physical address

address1
address2

city state zip

mailing address

address1
address2

city state zip

Director #2

Name

physical address

address1
address2

city state zip

mailing address

address1
address2

city state zip

Director #3

Name

physical address

address1
address2

city state zip

mailing address

address1
address2

city state zip

Fiscal Year:

Annual Meeting Date:

1000 Shares of no par value stock issued to:

Corporate Bank Account to be Established at:

Subchapter S Election:

Resident Agent:

Please Print and Mail or Fax form to
Law Offices of Karin A. Bentz
18 Dronningens Gade, Suite 8
Charlotte Amalie, St. Thomas, VI 00802