Panama Corporation - Order Form

Firstname:	*
Lastname:	*
Complete Delivery Address:
City:
State/Province:
Zip Code:
Country:
Home Phone:
Work Phone:
Fax:
E-mail:	*
Second E-mail (optional):
Preferred Method of Contact:

Yes Send me a:

	New Panama Corporation Package ($1000 + tax)
	New Panama Foundation Package ($1000 + tax)
	Panama Shelf Corporation Package ($1200 + tax)
	Panama Shelf Foundation Package ($1200 + tax)
	Complete Offshore Structure (New) Package ($2100 + tax)
	Complete Offshore Structure (Shelf) Package ($2900 + tax)

Note: Complete Offshore Structure Package includes corporation, foundation, bank account, brokerage account, general manager contract and mail forwarding service.

Note: Corporate annual franchise taxes (tasa unica) of $250 per entity are not included in the above mentioned prices.

Note: Annual fee of US$450 per entity includes resident agent, registered office, and optional nominee directors services. Annual fee is due one year after incorporation.

New Entity - Selecting a Name: (enter three name choices below)

Corporation Name Choices
Corporations must include any one of the following prefixes: "Inc", "Incorporated", "Corp", "Corporation" or "S.A.":

1.
2.
3.

Foundation Name Choices
Foundations must include the word,"Foundation" or "Fundación" in the name:

1.
2.
3.

Nominee Directors:

I wish to use Nominee Directors on my entity.

Nominee Directors can be provided at no additional charge.
If you want to provide your own directors, please complete the details below. Please note that you must provide us with a photocopy of passport for each director that you wish to appoint:

President:

Complete Name:
Physical Address:
City:
State/Province:
Zip Code:
Country:
Passport Country:
Passport Number:

Secretary:

Complete Name:
Physical Address:
City:
State/Province:
Zip Code:
Country:
Passport Country:
Passport Number:

Treasurer:

Complete Name:
Physical Address:
City:
State/Province:
Zip Code:
Country:
Passport Country:
Passport Number:

Please provide any additional details regarding directors that you wish for us to know:

Offshore Corporate Brokerage Account - Included:

Please send me application forms for the account and optional Corporate Cirrus Debit Card that are offered by the brokerage firm.

Additional Optional Corporate Accounts:

	Please assist me to set up a Corporate Online Discount Brokerage Account (Additional US$500 introduction / set up assistance fee).
	Please assist me to set up a Corporate Managed Currency Trading Account. (Additional US$500 introduction / set up assistance fee).
	Please assist me to set up a Panama Corporate Bank Account. (Additional US$700 introduction / set up assistance fee).
	Please assist me to set up a St. Vincent Corporate Bank Account. (Additional US$700 introduction / set up assistance fee)
	Please assist me to set up a Latvia Corporate Bank Account. (Additional US$700 introduction / set up assistance fee)
	Please assist me to setup an Antigua Corporate Bank Account. (Additional US$700 introduction / setup assitance fee)
	Please assist me to setup a Swiss Corporate Bank Account. (Additional US$700 introduction / setup assistance fee)
	Please assist me to set up a Corporate Merchant Account (Additional US$1500 introduction / set up assistance fee).

Mail Forwarding Services:

I would like to subscribe to one year of Mail Forwarding Services. This includes a Corporate Mail Box and Physical Address for my entity in Panama City, Panama to receive mail or courier packages. I understand that the corporations mail and courier packages will be forwarded to me per my instructions. Courier or post mail forwarding costs will be billed periodically. (US$300 per year)

Please provide the address that you would like your mail forwarded to:

Complete Name:
City:
State/Province:
Zip Code:
Country:
Indicate the method your mail should be forwarded to you:
Forwarding Frequency:

International Drivers License:

Please send me my own International Drivers License (US$500)

Additional Corporate Accounts & Agreements:

	Please send me an “Investment Advisor Contract” to document my relationship with my corporation (or foundation) as Investment Advisor. (Additional US$250).
	Please send me a “General Manager Contract” to document my relationship with my corporation (or foundation) as General Manager. (Additional US$250).
	Please send me a "Private Annuity Contract" to document the initial transfer to my Corporation as a purchase of a Private Annuity from my corporation. (Additional US$250).
	Please send me "Foundation Donation Forms" document the initial transfer to my Foundation as a Donation. (10 donation forms are included for a total of US$50).

Shipping Methods - Please send my Corporate Documents by:

	Airmail (no surcharge - included with purchase)
	Courier (US$50 extra)

Total Payment Amount:

Payment Options - Indicate how you would like to pay:

	Pay by Western Union: (We will email you the instructions). To protect your privacy and execute your order quickly, we recommend payment by Western Union. You will generally not need to file any reports or provide ID when sending Western Union money transfers to Panama.
	Pay by Money Gram: (We will email you the instructions).
	Pay by International Money Order: Paying by International Money Order is also an anonymous form of payment. However, please allow 3 weeks for clearing - we do not begin processing orders until payment has cleared. We will email you the payment instructions".
	Pay by USD Check: Only official USD bank checks are accepted. (We will email you the instructions).
	Pay by Wire Transfer: (We will email you the instructions).
	Pay by E-Gold: (We will email you the instructions).

Additional Requests or Comments:

Please review the information you have entered and make sure that you have entered all required information correctly. All orders are processed immediately.

I have read and agree to the disclaimers and notices. *

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Tel (Panama): ++(507)236 8303
Tel (Panama): ++(507)236 7069
Tel (Panama): ++(507)236 6286
Fax (Panama): ++(507)236 7150
Toll Free Voicemail / Fax (USA): 1-800-716-3452
Note: If calling to Panama from the US or Canada, you must dial "011" prior to the country code (507).

Email: info@panama-corporation.com
Encrypted Email: posinc@hushmail.com

Physical Address:
POSI, Inc.
Ave. Ricardo J Alfaro,
Sun Towers, 1st Floor, Office # 39
Panama City, Republic of Panama

PO Box Address:
POSI, Inc.
PTY 296, PO Box 0832 - 2745, WTC
Panama City, Republic of Panama

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DISCLAIMER: Panama-Corporation.com, Inc. is not a bank, broker, or merchant processor nor does it provide banking, brokerage, or merchant processing services. Panama-Corporation.com, Inc. (either directly or through its subsidiary law firm, Panama Offshore Legal Services) offers international company formation, corporate administration services, and bank/broker/merchant introductory / referral services and account processing services. Panama-Corporation.com, Inc. is not a brokerage firm, or investment advisory firm and does not offer investment or investment advisory services. This website is only used for promotional marketing purposes of Panama-Corporation.com, Inc. and is not intended to portray that this is the site of a bank, broker, merchant processor, investment advisory service, or any related financial services provider.

FURTHER DISCLAIMERS & NOTICES