Business Entity Registration Form
Please indicate your registration reason
*
Application for a new business
Application for a new location of an existing business
Amended application for an existing business
Other
Entity Name/Legal Name
*
2nd Name Choice if 1st is unavailable
Business Description
Federal Tax Identification Number, If applicable
*
Type of Business Entity
*
Limited Liability Company
Partnership
C-Corporation
S-Corporation
Sole Proprietorship
Doing Business As (DBA)
Other
Do you want S-Corp election?
Yes
No
Please confirm you have received advise from an attorney or Certified Public Accountant (CPA) regarding this entity structure and is fully aware this is the most suitable for your business.
Yes
No
County & State of Organization
*
Principal Place of Business
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact
The information must belong to authorized contact person of the entity.
Name and Surname
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Shipping Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Owner Information
The information must belong to designated owner of the entity.
Owner Type
Individual
Partnership
Company
Owner Name
First Name
Last Name
Registered Agent Information
Included (1st year is FREE, $150/annually thereafter)
Yes
No, see below
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is this LLC Manager Managed?
Yes
No (please disregard manager portion)
Member 1:
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Percentage of Ownership:
%
Member Type:
Managing Member
Member
Member 2 (if applicable)
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Percentage of Ownership:
%
Member Type:
Managing Member
Member
Manager 1: (Optional)
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Manager 2: (Optional)
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Officers: (Optional)
President
First Name
Last Name
Secretary
First Name
Last Name
Chairman
First Name
Last Name
Added Benefits
Included (1st year is FREE, thereafter you will be responsible for any fees.)
You will receive One Professional Email complimentary for 1 year. Please specify how you would like it to read.
Do you need a domain name? If yes, please specify your desired name in the "other" option
No
Yes
Other
Are there any other services needed for your business?
Accounting Services
Merchant Payment Processing
Setting up payroll
Reseller Permit
Website
Logo Design
Other
Do you have any questions? or comments?
Please acknowledge and understand this is not legal advice and none will be given regarding the structure of your business formation.
Yes
No
Date
*
-
Month
-
Day
Year
Date
Signature
*
Submit
Should be Empty: