Self-Directed IRA LLC Order Form Please complete all fields below: "*" indicates required fields Step 1 of 2 50% Self Directed IRA LLC*Single Member LLC $1495Two Member LLC $1695Customer Name* First Middle Last Customer Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail 2nd Member Name* First Middle Last 2nd Member Address* Same as Customer Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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.Filing State*Alabama $220Alaska $265Arizona $95Arkansas $60California $100Colorado $60Connecticut $300Delaware $100District of Columbia $165Florida $170Georgia $110Hawaii $110Idaho $110Illinois $160Indiana $100Iowa $60Kansas $185Kentucky $60Louisiana $90Maine $200Maryland $220Massachusetts $550Michigan $120Minnesota $190Mississippi $65Missouri $60Montana $80Nebraska $140Nevada $435New Hampshire $110New Jersey $140New Mexico $80New York $260North Carolina $135North Dakota $145Ohio $140Oklahoma $115Oregon $110Pennsylvania $135Rhode Island $165South Carolina $120South Dakota $135Tennessee $325Texas $325Utah $80Vermont $110Virginia $125Washington $220West Virginia $125Wisconsin $150Wyoming $110Includes surcharges for credit cards, online filing and/or copies. Nevada formation fees include the $150 Initial List of Officers/Members fee imposed by the state and filing for required Business License ($200) at the time of Annual List filing.Total Credit Card Cardholder Name Card Details EmailThis field is for validation purposes and should be left unchanged. Δ