Business Information Sheet
Part I
Business Name
*
Employer Identification Number (EIN)
*
Legal Name (DBA)
Date Incorporated
*
-
Month
-
Day
Year
Date
Email Address
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Business Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Physical Address (If Different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Back
Next
Part II
Additional Information
Tax Entity
*
Fiscal Year End
*
Business Industry
*
Does your business have employees
*
Yes. If so, please send us all your form 941 and 944
No.
Please submit a Profit & Loss Statement for this business
*
Browse Files
Cancel
of
Philadelphia City Tax Account #
Accounting Method
*
Cash
Accrual
Part III
Member/Partner/Shareholder Information
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
SSN or ITIN
*
Percentage Owned
*
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
SSN or ITIN
Percentage Owned
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Percentage Owned
SSN or ITIN
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Percentage Owned
SSN or ITIN
By signing this document, I attest that all the information that I have recorded is true and correct to the best of my knowledge
*
Date
*
-
Month
-
Day
Year
Date
Submit
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