Limited Liability Company

LIMITED LIABILITY COMPANY

Legal Information

Legal Name of the LLC

Trade Name / DBA (optional)

Number of members in the LLC

State Organized

Managing Member Information

Title

First Name

Middle Name

Last Name

Social Security Number

Activity

Reason for applying

Prime Activity

Please select

Specific Products or Services

Please select

Tell us more about your Retail activities

Specific Products or Services

Do you own or take title to the goods that you sell?

Do you receive a commission or fee from selling these goods?

Specific Products or Services

Please select

Specific Products or Services

What is the primary activity of your organization?

Specific Products or Services

Do you provide operating advice and assistance to businesses and other organizations?

Specific Products or Services

Do you own or take title to the goods that you sell?

Do you receive a commission or fee from selling these goods?

Specific Products or Services

Please select

Specific Products or Services

Please choose the primary mode used to transport passengers

Specific Products or Services

Please choose the primary mode used to transport cargo

Specific Products or Services

Please select

Specific Products or Services

Please select

Specific Products or Services

Please select

Please choose one of the following

Specific Products or Services

Please select

Do you focus on a single construction trade (concrete, framing, glass, roofing, siding, electrical, plumbing, HVAC, flooring, etc.)?

Specific Products or Services

Please specify your primary business activity in construction

Specific Products or Services

Please specify the type of goods that you manufacture and the primary materials used (such as “wood furniture”)

Please Select

Does your establishment include medical practitioners having the degree of M.D. (Doctor of medicine) or D.O. (Doctor of osteopathy)?

Please choose one of the following that best describes your primary business activity

Please select

Specific Products or Services

Do you focus on a single construction trade (concrete, framing, glass, roofing, siding, electrical, plumbing, HVAC, flooring, etc.)?

Please specify your primary business activity in construction

Specific Products or Services

General questions

Does your business plan to or currently accept Credit Card payments?

Yes

Does your business own a highway motor vehicle weighing 55,000 pounds or more?

Yes

Does your business involve gambling?

Yes

Does your business sell or manufacture alcohol, tobacco, or firearms?

Yes

Does your business pay federal excise taxes?

Yes

Has this LLC ever received or applied for an EIN before?

Yes

Previous EIN number, first 2 digits

Previous EIN number, last 7 digits

Do you have, or do you expect to have, any employees who will receive Forms W-2 in the next 12 months? (Forms W-2 require additional filings with the IRS.)

Yes

Number of Agricultural Employees

Number of Household Employees

Number of Other Employees

What is the first date wages or annuities were or will be paid?

Do you expect your employment tax liability to be $1,000 or less in a full calendar year? (January - December)?

Yes

Corporate Address (PO Boxes are not authorized)

Address

Address Line 1

City

State

Zip Code

Country

Do you want to receive your mail at another address?

Yes

Address

Address Line 1

City

State

Zip Code

Country

Dates

Date entity was started or acquired

Closing month of accounting year

Applicants Contact Information

Applicant’s First Name

Applicant’s Last Name

Email Address

Phone/Mobile

SMS Consent

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