NEW DELAWARE
BLOCKCHAIN CORPORATION
$3,779.95
FACT SHEET & DISCLOSURE STATEMENT

Online Secure Order Form (128 bit encryption)

PRICE INCLUDES:
  1. Coding and Deploying Your Corporation Cryptocoin memorializing the Corporation's Stock on the Ethereum Blockchain.
  2. Certificate of Incorporation (with Blockchain/Cryptocoin Capitalization Provision);
  3. Delaware State Filing Fees;
  4. Shareholders Agreement (with Blockchain/Cryptocoin Provision);
  5. Stock Certificate (memorializing Blockchain/Cryptocoin Smart Contract Address);
  6. Corporate Minutes;
  7. By Laws;
  8. Corporate Seal and Book; and
  9. Preliminary Name Search and Attorney's Fee!
Our fact sheet is used to gather information for the formation of your Blockchain Corporation. Please provide the name, purpose and details for the structure of your corporation. If you are not sure of the information that we are asking for you to provide, skip that section and we will review those details with you over the phone. Always include your contact information.

PERSONAL CONTACT INFORMATION
Name:
Address:
City:
State:
Zip Code:
   
Phone:
Your E-Mail:
Fax:
Cell Phone:


FOR PROFIT CORPORATION FACT SHEET

Name of Corporation:
In Delaware, the name of the corporation must include "association", "company", "corporation", "club", "foundation", "fund", "incorporated", "institute", "society", "union", "syndicated", "limited" or abbreviations thereof. The most popular choice is Inc. Please include any commas and periods.
Alternate Name:
Specify a second choice in case your name is not available.
   
  CRYPTOCOIN INFORMATION
The name of the Cryptocoin/Token will be the same as your Company
Cryptocoin/Token Ticker Symbol (3 or 4 letters)
Number of Corporate Share Units/Cryptocoins Supply
   
   
State of Incorporation: Delaware
Principal Nature of Business:
This answer will in no way limit the scope of your corporation.
Principal Products or Services:
Company Address:
City:
State:
Zip:
County:
Country:
   
Entity's Ethereum Wallet Public Address:
You will need an ethereum wallet to interact with any contracts on the Ethereum network, like storing unissued stocks/shares.
   

SHAREHOLDER INSTRUCTIONS
If you have fewer than four shareholders, simply leave additional fields blank. If you have more than four shareholders, simply add the additional shareholders in the comment section below.

Shareholder(1) Information Shareholder(2) Information
Name: Name:
       
Total # of Shares/Cryptocoins of the Corporation Owned by the Shareholder: Total # of Shares/Cryptocoins of the Corporation Owned by the Shareholder:
Shareholder(1) Ethereum Wallet Address:
***You must manage your own Private Key***		 Shareholder(2) Ethereum Wallet Address:
***You must manage your own Private Key***
       
Capital Contribution: Capital Contribution:
Address: Address:
City: City:
State: State:
Zip: Zip:
Phone: Phone:
SSN: SSN:
       
  If Shareholder is a Corporation, permissible trust, or estate, please provide us with the state and year of formation.   If Shareholder is a Corporation, permissible trust, or estate, please provide us with the state and year of formation.
State of Incorporation: State of Incorporation:
Year of Incorporation: Year of Incorporation:
       
Shareholder(3) Information Shareholder(4) Information
Name: Name:
       
Total # of Shares/Cryptocoins of the Corporation Owned by the Shareholder: Total # of Shares/Cryptocoins of the Corporation Owned by the Shareholder:
Shareholder(3) Ethereum Wallet Address:
***You must manage your own Private Key***		 Shareholder(4) Ethereum Wallet Address:
***You must manage your own Private Key***
       
Capital Contribution: Capital Contribution:
Address: Address:
City: City:
State: State:
Zip: Zip:
Phone: Phone:
SSN: SSN:
       
  If Shareholder is a Corporation, permissible trust, or estate, please provide us with the state and year of formation.   If Shareholder is a Corporation, permissible trust, or estate, please provide us with the state and year of formation.
State of Incorporation: State of Incorporation:
Year of Incorporation: Year of Incorporation:
       
 
DO YOU HAVE YOUR OWN ETHEREUM WALLET?
The Corporation and each Shareholder must have their own Ethereum Wallet and provide the Fire the Ethereum Wallet public address(es) for the entity and all Shareholders, if required, the Firm can assist our Clients to obtain Ethereum Blockchain Wallets for $267.95.

Select this checkbox if you would like for us to obtain your Ethereum Wallet.

DIRECTORS OF THE CORPORATION
Below, please list the names of the directors of your corporation. In most states, only one director is needed.
 
Director 1 Name

Director 1 SSN

Director 1 Address
 Director 3 Name

Director 1 SSN

Director 1 Address
Director 2 Name

Director 1 SSN

Director 1 Address
 Director 4 Name

Director 1 SSN

Director 1 Address
 
OFFICERS OF THE CORPORATION
Officers of a corporation usually include a president, vice-president, secretary, and a treasurer. In most states one officer can hold all positions. Fill in the appropriate name or names for the officers.
 
President Name

President SSN

President Address

 Vice-President Name

Vice-President SSN

President Address
Secretary

Secretary SSN

Secretary Address
 Treasurer Name

Treasurer SSN

Treasurer Address
 



BILLING INFORMATION * REQUIRED

Name (as appears on card)

Billing Address

Billing City

Billing State

 Billing Zip



CREDIT CARD DETAILS * REQUIRED

 
Credit Card Number

Expiration Date
   
Card security code
 

Payment Amount



Enter the security code, ABC123 , in the following text box:
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