New Business Client - General Information Form
Please fill out the following information about your company and parties involved. If you have multiple businesses, please fill a separate form for each one.
BASIC BUSINESS INFORMATION
Basic information about your business and type of business.
First Name (of person filling this form)
*
Last Name (of person filling this form)
*
Employer Identification Number (EIN)
*
Federal ID number (EIN)
State Withholding Number
("1234567-000" or "12345678-000" format for CT Department of Revenue Services)
State Registration Number
May be referred to as "state account number" or "state unemployment ID/number" or "Dept. of Labor number"("12-345-67" format for CT; number is obtained from CT Department of Labor)
Any other state ID numbers
*
If none, type "none."
Company Name
*
LLC, INC, CORP, PC, etc. - Legal entity name
Doing business as (DBA) name
Business type
*
C Corporation
S Corporation
LLC
Single-member LLC
Sole proprietorship
Partnership
Mobile Phone Number
*
Authorized signer/account representative information - the main contact person for all your accounting and tax related matters.
Company Email Address (main point-of-contact for this business)
*
Confirmation Email
Authorized signer/account representative information - the main contact person for all your accounting and tax related matters.
Date business began
*
-
Month
-
Day
Year
If you are an existing business, you can find this on your business tax return, page 1. Otherwise, please tell us the date you started operations.
Date EIN applied for
*
-
Month
-
Day
Year
Find this on on the EIN letter received when you first registered the business with the IRS or your business tax return, page 1.
How did you hear about us?
Our website
Google
Yelp
Referral
Other
If you checked Referral in the previous question, please tell us who referred you:
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BUSINESS PHYSICAL ADDRESS
Please provide your business's physical address where you conduct business. If you would like to add a mailing address for confidential communications, please specify as such on the next page.
Business Address
*
Business Address 1
Business Address Line 2 (Unit #)
Business Town / City
State
Zip Code
Business Address State
*
Business Address Zip Code
*
Does your business have a separate mailing address?
*
Same as business address
Different
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MAILING ADDRESS
Please provide a mailing address if you would like confidential communications to be sent to a separate address.
Mailing Address
*
Street Address
Street Address Line 2 (Unit #)
Town / City
State
Zip Code
Mailing Address State
*
Mailing Address Zip Code
*
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BANKING INFORMATION
Please fill the following about your main business bank account where the majority of activity occurs. Additionally, you should make a view-only/external user for your online banking for us. This way, we can retrieve what we need without waiting for clients to provide the information.
Bank/Financial Institution Name
*
(Bank/Financial institution name)
Routing Number
*
Account Number
*
What type of account is this?
*
Checking
Savings
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AUTHORIZED REPRESENTATIVE INFORMATION
This is the person who will sign on behalf of the company, and who we will contact first regarding anything for this business. **It is up to this person to communicate anything else to other members/partners.**
Authorized Representative First Name
*
Authorized Representative Last Name
*
Authorized Representative Social Security Number (SSN)
*
Authorized signer/account representative information - the main contact person for all your accounting and tax related matters.
Birth Date
-
Month
-
Day
Year
Date
Authorized Representative Home Address
*
Street Address
Street Address Line 2 (Unit #)
Town / City
State / Province
Postal / Zip Code
Authorized Representative State
*
Authorized Representative Zip Code
*
Authorized Representative Allocation Percentage of Authorized Representative
*
In other words, the ownership percentage (if a partnership entity - S Corp., LLC, etc.). If only one owner, please write 100.
Do you have any other partners/members?
*
Yes
No
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PARTNER/MEMBER 2 INFORMATION
Complete the following if you have other partners/members in your business.
Partner/Member 2 First Name
*
Partner/Member 2 Last Name
*
Partner/Member 2 SSN (individual)
*
Birth Date
-
Month
-
Day
Year
Date
What type of partner is this? Choose the level of involvement.
*
General partner (active in business)
Limited partner (passive in business, not in operations)
Partner/Member 2 Address
*
Street Address
Street Address Line 2 (Unit #)
Town / City
State / Province
Postal / Zip Code
Partner/Member 2 State
*
Partner/Member 2 Zip Code
*
Partner/Member 2 Email Address
*
Confirmation Email
example@example.com
Allocation Percentage of Partner/Member 2
*
Ownership percentage of business (if a partnership entity - S Corp., LLC, etc.)
Do you have any other partners/members?
*
Please Select
Yes
No
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PARTNER/MEMBER 3 INFORMATION
Complete the following if you have other partners/members in your business.
Partner/Member 3 First Name
*
Partner/Member 3 Last Name
*
Partner/Member 3 SSN (individual)
*
Birth Date
-
Month
-
Day
Year
Date
What type of partner is this? Choose the level of involvement.
*
General partner (active in business)
Limited partner (passive in business, not in operations)
Partner/Member 3 Home Address
*
Street Address
Street Address Line 2 (Unit #)
Town / City
State / Province
Postal / Zip Code
Partner/Member 3 State
*
Partner/Member 3 Zip Code
*
Partner/Member 3 Email Address
*
Confirmation Email
example@example.com
Partner/Member 3 Allocation Percentage of Partner/Member 3
Ownership percentage of business (if a partnership entity - S Corp., LLC, etc.)
Do you have any other partners/members?
*
Please Select
Yes
No
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PARTNER/MEMBER 4 INFORMATION
Complete the following if you have other partners/members in your business.
Partner/Member 4 First Name
*
Partner/Member 4 Last Name
*
Partner/Member 4 SSN (individual)
*
Birth Date
-
Month
-
Day
Year
Date
What type of partner is this? Choose the level of involvement.
*
General partner (active in business)
Limited partner (passive in business, not in operations)
Partner/Member 4 Home Address
*
Street Address
Street Address Line 2 (Unit #)
Town / City
State / Province
Postal / Zip Code
Partner/Member 4 State
*
Partner/Member 4 Zip Code
*
Partner/Member 4 Email Address
*
Confirmation Email
example@example.com
Allocation percentage of Partner/Member 4
*
Ownership percentage of business (if a partnership entity - S Corp., LLC, etc.)
Do you have any other partners/members?
*
Please Select
Yes
No
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PARTNER/MEMBER 5 INFORMATION
Complete the following if you have other partners/members in your business.
Partner/Member 5 First Name
*
Partner/Member 5 Last Name
*
Partner/Member 5 SSN (individual)
*
Birth Date
-
Month
-
Day
Year
Date
What type of partner is this? Choose the level of involvement.
*
General partner (active in business)
Limited partner (passive in business, not in operations)
Partner/Member 5 Home Address
*
Street Address
Street Address Line 2 (Unit #)
Town / City
State / Province
Postal / Zip Code
Partner/Member 5 State
*
Partner/Member 5 Zip Code
*
Partner/Member 5 Email Address
*
Confirmation Email
example@example.com
Allocation percentage of Partner/Member 5
*
Ownership percentage of business (if a partnership entity - S Corp., LLC, etc.)
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By electronically signing this form, I certify that I have answered all questions herein accurately and completely. I certify that I am the authorized signer for this business and take full responsibility for the data submitted.
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