Self Directed IRA LLC Order Form

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Self Directed IRA LLC*

Choose Single Member or Two Member (i.e. add spouses IRA, other please call us).

Customer Name*

First Middle Last

Customer Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

2nd Member Name

First Middle Last

2nd Member Address

Same as Customer Address

Street Address Address Line 2 City State ZIP Code

Filing State*

Includes surcharges for credit cards, online filing and/or copies. May also include additional state fees for additional required services.

Annual Compliance Package $495*

Yes, please add Annual Compliance Package

No, I decline Annual Compliance Package

Annual Compliance Package including Registered Agent Services, Annual Report Filing Service, Private Client Portal and Support, renews each year at $495 annually plus applicable state filing fees unless canceled 30 days in advance of due date. Invoice sent 90 days in advance.

Name of Registered Agent

All LLC's are required by Secretary of State to have a Registered/Resident/Statutory Agent for service of process.

Address of Registered Agent

Street Address Address Line 2 City State ZIP Code

Choose a Name for Your LLC*

Choose up to three names (i.e. XYZ Ventures LLC, ABC Investments LLC, Smith Holdings LLC etc.) for your LLC. List in order of preference one name to a line.

Total

Credit Card*

Cardholder Name

Card Details

SMS Consent

I Consent

I agree to receive SMS from Self Directed IRA LLC (Nationwide Corporate Services, Inc.). Message/data rates may apply. Reply STOP to opt out, HELP for help. Consent isn’t a condition of purchase