Delaware LLC. Premium Formation Service, $ How did you hear about us? Name of Limited Liability Company

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1 The below form may be completed using Adobe Acrobat Reader, then printed. Or, you may print the form and complete it by hand. Then, mail or fax the form to Advantage Delaware LLC. Delaware LLC Premium Formation Service, $ How did you hear about us? Name of Limited Liability Company Name must include the words "Limited Liability Company" or the abbreviation "L.L.C." or the designation "LLC." The name may also contain the words: Association, Company, Club, Foundation, Fund, Institute, Society, Union, Syndicate, Limited, or Trust (or their abbreviations). Please supply a second name choice, in the event your first name choice is in use by another company. First Choice: Second Choice: Communications Contact Person As your Delaware Registered Agent we require contact information of the person authorized to receive official correspondence and billing. Remember, if this information changes you are responsible for notifying us of the change in a timely manner. First Name: Middle initial: Last Name: Address 1 ( P.O.): State or Province: Zip or Postal Code: Telephone: Fax: Address: page 1 of 5

2 Members If you want to name the member(s) and/or manager in the Certificate of Formation, please provide the name(s) and title below. (There is no requirement in Delaware to disclose the name of member(s) and/or manager in the Certificate of Formation. However, this provision may prove to be useful for nonresident or foreign owned LLCs which operate outside the U.S. and will be ordering an Apostille attached to the Certificate of Formation.) Employer Identification Number (EIN) Every business entity should obtain an Employer Identification Number (EIN), also known as the Federal Tax Identification Number from the Internal Revenue Service. When selecting our Premium LLC Formation Service we offer to fill in the application and obtain the EIN for your LLC. I instruct Advantage Delaware LLC to obtain the EIN for my new company. Required Information. Please supply the following information so we can apply for and obtain your EIN. First Name: Middle Initial: Last Name: Officer Title: Phone: Do You have a valid Social Security Number? Social Security Number: Principle Place of Business Where is your business physically located? The physical location of the LLC or Corporation can be located in any state; it is not required to be in Delaware. Address 1: County: State: Province: Zip or Postal Code: page 2 of 5

3 Employees Do you currently have or do you expect to have any employees in the next 12 months? Please supply the highest number of employees expected within the next 12 months. Please te: Total number of employees must be at least 1. Number of agricultural employees: Number of household employees: Number of other employees: Do you expect to pay less than $4000 in total wages during the next full calendar year (January December)? Primary Business Activity Please choose the category that best describes your business: Accommodation Construction Finance Food Service Health Care Insurance Manufacturing Real Estate Rental and Leasing Social Assistance Transportation Warehousing Wholesale Other Please give a brief description of your business activity: Have you ever applied for or received an EIN for this business previously? If yes, please enther EIN number: page 3 of 5

4 Additional Services Please te: Delaware may take several weeks to process an Apostille unless expedited service is requested. Expedited Formation Service, within 24 hours - $90 Expedited Formation Service, same day processing - $150 Apostille - $30 per document Apostille with expedited service - $80 per document Country requesting Apostille: Federal Express International Delivery (for Documents Only) - $75 Delaware Address with Mail Forwarding (within the U.S.) - $300 per year Extra Services: If you require any additional services we offer please list in the box provided below. For example: multiple copies of certificates or apostilles, expedited processing service, international mail forwarding, opening a Delaware bank account, or creating a presence in Delaware. You may use this PDF version of the form and fax to us at and we will promptly respond with a price quote, or contact us by phone at , or toll free at Payment Information All information is required Cardholder s Name: Credit Card: Visa MasterCard American Express Discover Credit Card Number: Security Code (CVV number): Visa, MasterCard, Discover - CVV 3 digit codes are located on the back of your card. American Express - CVV 4 digit codes are located on the front of your card. Expiration Date (mm/dd/yyyy): Signature Date page 4 of 5

5 Billing Address Billing Address is same as Contact Person Address (page 1) Card Billing Address 1: State or Provence: ZIP or Postal Code: Submitting This Form To submit this form by Fax: To make credit card payment by telephone call toll free: , for international clients please call To submit this form by mail, address to: Advantage Delaware LLC 35A The Commons page 5 of 5