0001859564-21-000001.txt : 20210608 0001859564-21-000001.hdr.sgml : 20210608 20210608171329 ACCESSION NUMBER: 0001859564-21-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20210608 DATE AS OF CHANGE: 20210608 EFFECTIVENESS DATE: 20210608 FILER: COMPANY DATA: COMPANY CONFORMED NAME: AFFIRMXH INC. CENTRAL INDEX KEY: 0001859564 IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-402145 FILM NUMBER: 211002996 BUSINESS ADDRESS: STREET 1: 1005 TAHOE GLEN PLACE CITY: CARY STATE: NC ZIP: 27513 BUSINESS PHONE: 408-888-1281 MAIL ADDRESS: STREET 1: 1005 TAHOE GLEN PLACE CITY: CARY STATE: NC ZIP: 27513 D 1 primary_doc.xml X0708 D LIVE 0001859564 AFFIRMXH INC. 1005 TAHOE GLEN PLACE CARY NC NORTH CAROLINA 27513 408-888-1281 DELAWARE None None Corporation true 2020 IAN SHADFORTH 1005 TAHOE GLEN PLACE CARY NC NORTH CAROLINA 27513 Executive Officer Director THOMAS HALL 1005 TAHOE GLEN PLACE CARY NC NORTH CAROLINA 27513 Director FRANK WESTERMANN 1005 TAHOE GLEN PLACE CARY NC NORTH CAROLINA 27513 Director LEIF BOWMAN 1005 TAHOE GLEN PLACE CARY NC NORTH CAROLINA 27513 Director Other Technology Decline to Disclose 06b false 2021-06-08 false true true false 10000 1799959 305000 1494959 Series Seed Preferred Stock false 7 0 0 0 ALL PROCEEDS SHALL BE USED AS WORKING CAPITAL false AFFIRMXH INC. /s/Ian Shadforth Ian Shadforth CEO 2021-06-08