Online Company Order Form (Alpha Version: 5.3.0.0)

Please read the following before proceeding:

1. The following online order form is for Professionals Firms (eg. Solicitors, Accountants, etc) only

2. Private Individuals and General Public will need to download and print our .pdf form. Download Form Here

3. The following online order form only allows for a maximum of 4 entities to be inserted. If your company requirements are greater than this, please download our .pdf form and fax it to us on 07 3221 9982 Download Form Here

RAPID COMPANIES - Agent Company Order Form – for Professional Clients ONLY

Contact *:

Firm Name *:

Phone *:

Fax:

Email *:

COMPANY NAME: Is company to act solely as trustee for a Self-Managed Superannuation Fund?:

Superannuation Fund *:
YesNo

1st Preference *:

2nd Preference:

N.B. Proposed company names that are currently registered as business names.
We confirm, when signing as a shareholder below, that the proprietors of the registered business name are the shareholders of the proposed company.

OFFICEHOLDERS & MEMBERS :

Full Name (surname first) or for a corporate shareholder Company Name and A.C.N. *:

Residential Address or if a corporate shareholder, Registered Office Address *:

Postcode *:

Date of Birth :

Select Date

(dd/mm/yyyy)

Place of Birth:Town/City :

State/Country *:

Has consented to act as *:
DirSecS’hlderChairmanPublic Officer

If shareholder :

No. of Shares *:

Class of Shares *:

Nom. Value (P/share) *:

Are Shares to be jointly held? *:
YesNo

Are Shares to be Beneficially Held? *:
YesNo

Full Name (surname first) or for a corporate shareholder Company Name and A.C.N. :

Residential Address or if a corporate shareholder, Registered Office Address:

Postcode :

Date of Birth :

Select Date

(dd/mm/yyyy)

Place of Birth:Town/City :

State/Country :

Has consented to act as :
DirSecS’hlderChairmanPublic Officer

If shareholder :

No. of Shares :

Class of Shares :

Nom. Value (P/share) :

Are Shares to be jointly held?:
YesNo

Are Shares to be Beneficially Held? :
YesNo

Full Name (surname first) or for a corporate shareholder Company Name and A.C.N. :

Residential Address or if a corporate shareholder, Registered Office Address :

Postcode:

Date of Birth:

Select Date

(dd/mm/yyyy)

Place of Birth:Town/City:

State/Country:

Has consented to act as:
DirSecS’hlderChairmanPublic Officer

If shareholder :

No. of Shares:

Class of Shares:

Nom. Value (P/share):

Are Shares to be jointly held?:
YesNo

Are Shares to be Beneficially Held?:
YesNo

Full Name (surname first) or for a corporate shareholder Company Name and A.C.N. :

Residential Address or if a corporate shareholder, Registered Office Address :

Postcode:

Date of Birth:

Select Date

(dd/mm/yyyy)

Place of Birth:Town/City:

State/Country:

Has consented to act as:
DirSecS’hlderChairmanPublic Officer

If shareholder :

No. of Shares:

Class of Shares:

Nom. Value (P/share):

Are Shares to be jointly held?:
YesNo

Are Shares to be Beneficially Held?:
YesNo

ULTIMATE HOLDING COMPANY

Name of Ultimate Holding Company upon Registration (if applic.) :

ACN/ARBN/ABN :

Country of Registration (if not Aust.) :

REGISTERED OFFICE (A CORNER STREET ADDRESS IS NOT ACCEPTABLE FOR BELOW ADDRESS)

(At office of) C/- :

Unit of office :

Level :

Building Name :

Street Number and Name *:

Suburb/City *:

State/Territory *:

Postcode *:

Does the company occupy these premises *:
YesNo

PRINCIPAL PLACE OF BUSINESS (A CORNER STREET ADDRESS IS NOT ACCEPTABLE FOR BELOW ADDRESS)

Unit of Office :

Level :

Building Name :

Street Number and Name *:

Suburb/City *:

State/Territory *:

Postcode *:

Please choose your package * :
$745.00 (incl. GST) - Regular Bound Package
$646.00 (incl. GST) - Emailed PDF Version only

RE:	BANK DETAILS
PAYMENT BY BANK DEPOSIT
BANK:	Bank of Queensland
BRANCH:	229 Elizabeth Street, Brisbane 4000
BSB:	124001
ACCOUNT NUMBER:	10 341 706
ACCOUNT NAME:	Rapid Companies

Agent on behalf of Officeholder/Member (Professionals Firms)

This section must be completed [by the Firm ordering the company] before we can register the company. - The Directors have consented in writing to be Directors for the purpose of registering the company and to the issue of the shares as stated and have asked Rapid Companies to act as agents for the sole purpose of registration.

Signed *:
Signed *

Print Name *:

Date *:

Select Date

Proposed company names that are currently registered as business names - We [the Firm ordering the company] confirm that the proprietors of the registered business name are the members of the proposed company.

Signed :
Signed

Print Name :

Date :

Select Date

Payment Options - please choose one *:
Direct Credit – Confirmation of payment to be faxed to 07 3221 9982 or emailed to Rapid Companies
Credit Card – Contact Rapid Companies with details on 07 3229 8311
7 Day Approved Account

A PDF copy of this form will be sent to your email address.