Business StartUp Assistance Intake Form

Name*

First NameLast Name

Contact Number*

Format: (000) 000-0000.

E-mail*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Business Name*

Business DBA (if applicable)

Type of Service Your Business Offers*

Sole ProprietorLLCS CorporationNon Profit( please contact before completing)

One Member LLCTwo Member LLCThree Member LLC

*If you have multiple board members, please list their names here. *If forming a Non Profit, please list your board members complete names, addresses ,and contact numbers.

NON PROFIT ONLY!! What is your mission statement /the purpose of your non profit?

NON PROFIT FORMATION TIMEFRAME IS 15-30 days(longer if IRS issue exists) after ALL required documents have been received. Please initial to verify read receipt.

Social Security Number (needed to obtain Business EIN) *may choose to call and provide

Additional information you may want us to know:

My Products

Business Services ( Foreign Only) Out of state businesses wishing to do business in Alabama

Fee Based Services Include:Articles of Incorporation filing / Business name registration with the state fee/ Secretary of State filing fee / Probate court filing fee / Employer Identification Number EIN setup / Annual Registered Agent service fee—Complimentary:DUNS number setup assistance / Net 30 vendor listings / Marketing and business listing setup / Available grant and loan resource listings

$850.00

Non Profit SetUp

EIN, NON PROFIT ARTICLES OF INCORPORATION/REGISTER NON PROFIT WITH STATE/CAGE NUMBER/SAMS NUMBER/GOVERNMENT DUNS NUMBER/ETC....

$1,500.00

Domestic Business Services (State of Alabama Businesses Only)

Fee Based Services Include:Articles of Incorporation filing / Business name registration with the state fee/ Secretary of State filing fee / Probate court filing fee / Employer Identification Number EIN setup / Annual Registered Agent service fee——Complimentary:DUNS number setup assistance / Net 30 vendor listings / Marketing and business listing setup / Available grant and loan resource listings

$750.00

Yearly RA Fee

RA Annual Servicing FeeThis fee is due every year. No refund once services have begun.

$199.99

Additional LLC RA SERVICES

$99.00 Quantity

Total

$0.00

I hereby certify that all information provided is true, accurate, and complete to the best of my knowledge. I authorize D5 Tax Services to act on my behalf solely for matters related to the formation and registration of my business, based strictly on the information I provide. I understand and acknowledge that D5 Tax Services is not a law firm and does not provide legal advice, legal representation, or legal opinions.I accept full responsibility for the accuracy, completeness, and timeliness of all information and documents submitted. I understand that D5 Tax Services relies entirely on the information provided by me and is not responsible or liable for errors, omissions, delays, rejections, penalties, or additional fees resulting from inaccurate, incomplete, or misleading information supplied by me or from actions taken by third parties or government agencies.I further understand and expressly agree that all fees paid to D5 Tax Services are non refundable. No refunds will be issued under any circumstances once payment is made, regardless of service outcome, processing delays, client error, change of decision, or denial by any federal, state, or local agency.By signing below, I acknowledge that I have read, understood, and voluntarily agree to these terms. I consent to the terms of service and authorize D5 Tax Services to proceed with the requested business startup services as outlined.

Business StartUp Intake Form