Order Form Company Incorporation

ORDER FORM – COMPANY INCORPORATION

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Orders received and paid for by midday are completed and sent by Express Post on the same day.

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PREFERRED COMPANY NAME: / 2nd Preference:
Check that the desired name is available – ASIC Identical Names Check:
Principal Place of Business:
Address of Registered Office (‘PO Box’ not accepted):
Name of Occupier of Registered Office:
Business Number & StateIf preferred company name is identical to that of a registered business name in any or multiple Australian regions, all the business name(s) must be owned by at least one of the Directors listed below.
Business Number: if app. / State Business is Registered:if app.
Name of Director that owns business name:
Director (1)AND Public Officer (MUST BE AT LEAST 1 DIRECTOR) / Title: Mr / Mrs / Ms / Miss / Dr
Full Name:
Residential Address:
Date of
Birth: / ____/_____/____ / Place of Birth: / City/Town: / State: / Country (if not Australia):
Director (2)If more than two directors please complete additional page / Title: Mr / Mrs / Ms / Miss / Dr
Full Name:
Residential Address:
Date of
Birth: / ____/_____/____ / Place of Birth: / City/Town: / State: / Country (if not Australia):
Secretary (OPTIONAL) / Title: Mr / Mrs / Ms / Miss / Dr
Full Name:
Residential Address:
Date of
Birth: / ___/_____/____ / Place of Birth: / City/Town: / State: / Country (if not Australia):
Director (3) / Title: Mr / Mrs / Ms / Miss / Dr
Full Name:
Residential Address:
Date of
Birth: / ____/_____/____ / Place of Birth: / City: / State: / Country:
Director (4) / Title: Mr / Mrs / Ms / Miss / Dr
Full Name:
Residential Address:
Date of
Birth: / ____/_____/____ / Place of Birth: / City: / State: / Country:
Director (5) / Title: Mr / Mrs / Ms / Miss / Dr
Full Name:
Residential Address:
Date of
Birth: / ____/_____/_____ / Place of Birth: / City: / State: / Country:
Shareholder (1)If companyprovide ACN & Registered Office address / Title (if applicable): Mr / Mrs / Ms / Miss / Dr
Full Name:
ACN (if applicable):
Residential/Registered Office Address (as applicable):
Shares: / Number of Shares / Type of Shares: / Par Value of Shares: / Beneficial Owner (if not shareholder named above) and Residential/Registered Office Address (as applicable):
$ ea
Shareholder (2)If more than 2 shareholders complete additional page / Title (if applicable): Mr / Mrs / Ms / Miss / Dr
Full Name:
ACN (if applicable):
Residential/Registered Office Address (as applicable):
Shares: / Number of Shares / Type of Shares: / Par Value of Shares: / Beneficial Owner (if not shareholder named above) :
$ ea
Shareholder (3)If companyprovide ACN & Registered Office address / Title (if applicable): Mr / Mrs / Ms / Miss / Dr
Full Name:
ACN (if applicable):
Residential/Registered Office Address (as applicable):
Shares: / Number of Shares / Type of Shares: / Par Value of Shares: / Beneficial Owner (if not shareholder named above):
$ ea
Shareholder (4)If companyprovide ACN & Registered Office address / Title (if applicable): Mr / Mrs / Ms / Miss / Dr
Full Name:
ACN (if applicable):
Residential/Registered Office Address (as applicable):
Shares: / Number of Shares / Type of Shares: / Par Value of Shares: / Beneficial Owner (if not shareholder named above):
$ ea
Shareholder (5)If companyprovide ACN & Registered Office address / Title (if applicable): Mr / Mrs / Ms / Miss / Dr
Full Name:
ACN (if applicable):
Residential/Registered Office Address (as applicable):
Shares: / Number of Shares / Type of Shares: / Par Value of Shares: / Beneficial Owner (if not shareholder named above):
$ ea
I/We understand you require full upfront payment with this order for wholesale $763incl. GST. This includes the ASIC fee of $488updated as of 1st July 2018.
Payment options - cheque, direct deposit/electronic transfer or credit card (Visa, MasterCard, Bankcard only).
Orders will be processed once payment has been received; this may take up to two days if payment is made via direct deposit/electronic transfer.
Please contact our office if you wish to pay via credit card or send your details with your order.
Fees are subject to change without notice.
I/We confirm thatwe have not requested advice from you in relation to this company including but not limited to the appropriateness of the parties or any taxation consequences.
Sender: / Contact Person:
Shipping Address:
Telephone: / Fax: / Email: