NEW DELAWARE BLOCKCHAIN
LIMITED LIABILITY COMPANY
$3,779.95

FACT SHEET & DISCLOSURE STATEMENT

Online Secure Order Form (128 bit encryption)
PRICE INCLUDES:
  1. Coding and Deploying Your LLC Cryptocoin memorializing the LLC Membership Interest on the Ethereum Blockchain.
  2. Certificate of Formation (with Blockchain/Cryptocoin Capitalization Provision);
  3. Delaware State Filing Fees;
  4. Operating Agreement (with Blockchain/Cryptocoin Provision);
  5. Membership Certificate (memorializing Blockchain/Cryptocoin Smart Contract Address);
  6. LLC Minutes, LLC Regulations;
  7. LLC Seal and Book; and
  8. Preliminary Name Search and Attorney's Fee!
Our fact sheet is used to gather information for the formation of your Blockchain Company. Please provide the name, purpose and details for the structure of your company. 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:
Skype Name for International:


LIMITED LIABILITY COMPANY FACT SHEET
Name of LLC:
In Delaware, the name of your Limited Liability must contain either "Limited Liability Company", "L.L.C." or "LLC". The most popular choice is "LLC". 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 LLC Ownership Units/Cryptocoins Supply
   
   
State of Organization: Delaware
Principal Nature of Business:
This answer will in no way limit the scope of your limited liability company.
Principal Products or Services:
   
Company Street 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.
   

MEMBER INSTRUCTIONS
If you have fewer than four members, simply leave additional fields blank.

Single member LLC are not recommended. We strongly recommend having two or more owners when forming an LLC. This can be addressed once we receive and examine your order. Please complete the rest of this order form.
Please provide us with the name of each Member, total percentage of ownership in the LLC, the number of ownership units/Cryptocoins the member will hold,  address, city, state, zip and Social Security Number of the Members below. If a Member is a Corporation, permissible trust, or estate, please provide us with the state and year of formation.

If you have fewer than four Members, simply leave additional fields blank. If you have more than four Members, simply add the additional Members in the comment section below. A husband and wife will probably want to own the Membership Interest as Tenants by the Entireties together at no extra charge.

 
 
Membership(1) Information Membership(2) Information
Member Name: Member Name:
       
Total # of Ownership Units/Cryptocoins of the LLC: Total # of Ownership Units/Cryptocoins of the LLC:
Member(1) Ethereum Wallet Address:
***You must manage your own Private Key***		 Member(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:
       
       
Membership(3) Information Membership(4) Information
Member Name: Member Name:
       
Total # of Ownership Units/Cryptocoins of the LLC: Total # of Ownership Units/Cryptocoins of the LLC:
Member(1) Ethereum Wallet Address:
***You must manage your own Private Key***		 Member(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:
 
Total Capital Contribution: Add Capital Contribution amounts from members above.
Capital Contributions can be made up of contributed cash, property (any contribution of property must include a description of the property), promissory note or services rendered. Capital contributions can also consist of other obligations to be contributed by Member(s) in the future, cash, property (any contribution of property must include a description of the property) and services to be performed.


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.

MANAGERS OF THE LLC
Below, please list the names of the operating managers of your LLC. In most states, only one operating manager is needed.
 
Operating Manager Secretary
Vice-Operating Manager Treasurer
 



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:

We have taken the necessary measures to guarantee that any client information submitted to our secure server will not be intercepted by unauthorized parties. Without you having to download any additional software, your information is automatically protected with a 128 bit encryption certificate. Double click on the Gold Padlock on the bottom right of your browser's screen to bring up details of our SSL Security certificate.