3.2 - Information for us to Prepare an Application for an Employer Identification Number (EIN)

3.2 - Information for us to Prepare an Application for an Employer Identification Number (EIN)
Applicant Type:

IndividualPartnershipEstateTrustLLCCorporationOther
If not an individual, provide State/Province and Country of Formation (also provide copy of formation or incorporation document, trust deed, or death certificate, will and proof of appointment as applicable)
Legal Name of Applicant*
Operating Name of Applicant
Fiscal Year End of Applicant*
Name and Title of Responsible Party (if Entity)*

PrefixFirst NameMiddle NameLast NameTitle
SSN, ITIN or EIN of Responsible Party
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Phone Number*

Country CodeArea CodePhone Number
Email
example@example.com
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By drawing my signature in the box, I certify that the information provided is true, accurate & complete I understand that if I submit the information by clicking the Green Submit Button that the information will be emailed to Bazar McBean and to me as a PDF. I understand that I may alternatively choose to print the information and submit it in an alternative manner.*
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