9/1 LLC-Disregarded Entity Profile

LLC-Disregarded Entity Profile

Please provide information on your ONE owner LLC
ABOUT THIS FORM: Please be sure you review your information carefully. The information provided on this form will be used in our firm client database and tax reporting.

Estimated Time to Complete: 5 - 15 minutes
LLC INFORMATION:
LLC Registered Name*
Enter the name of your LLC
Assumed Name (or DBA)
Enter ONLY if you have a DBA
Email Address Policy:

The Primary Email is our mailing address where sensitive tax material may be sent. This is the email used for all firm communication and you will need to monitor your email periodically for important firm notifications.
Primary Email*
example@example.com
Secondary Email
example@example.com
Click on "Go to Next Page" to continue with your questionnaire. Need more Time? Click "Save for Later" only if you need to save your data and return later. If you do click Save for Later, you will receive an email with a link so you can return to it for completion.

Business Mailing Address and Phone
LLC Mailing Address (PO BOX is not allowed)*

Street Address

CityState

Zip Code
LLC - Preferred Phone*
LLC Bank Name
Business Tax ID Numbers
Federal ID*
Enter your Federal Tax ID number
If you do not have a Federal ID number for your LLC, please enter "NONE" in the box provided.
State ID*
Enter your State Tax ID number
If you do not have a State ID number for your LLC, please enter "NONE" in the box provided.

Sole LLC Owner Contact Information

A Disregarded LLC an only have ONE owner on record.
Name*

First NameMiddle NameLast Name
LLC Owner Home Address

Street Address

Street Address Line 2

CityState

Zip Code
LLC Owner - Preferred Contact Number
Please enter a valid phone number.
LLC Owner Date of Birth

MonthDayYear
Primary Contact Date of Birth
LLC Owner - Social Security Number
Primary Contact SSN
Ownership % (Must be 100%)
All Dis-regarded LLC's must be one owner
Do you have other Officers/Governors of the LLC not listed?
Please list name of additional owners not on this form. We will gather additional information on a separate form.

LLC-Disregarded Entity Profile