9/1 Company Profile Information

Company Profile Information
ABOUT THIS DATA FORM: Please be sure to review this 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
Company Information
Registered Business Name*
Assumed Name (or DBA)
Email Address Policy: The PRIMARY EMAIL is 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
Alternate Email (optional)
example@example.com
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Business Mailing Address and Phone
Business Mailing Address (PO Box is not allowed)*

Street Address

Street Address Line 2

CityState

Zip Code
Business Phone
Please enter a valid phone number.Format: (000) 000-0000.
Business Bank Name
Business Tax ID Numbers
YOUR BUSINESS TAX REPORTING NUMBERS: Please provide your Federal, State, and State Unemployment numbers.
Federal ID
Enter your Federal Tax ID
State ID
Enter your State Tax ID
State Unemployment ID
Enter your State Unemployment ID
NOTE: If you do not have a number, please enter "NONE" in the box provided.
What is the current tax filing entity of the business?

S-CorporationC-CorporationLLC - S-CorporationLLC - C-CorporationLLC - PartnershipLLC - DisregardedUnsure

Business PRIMARY Contact/Owner:

The PRIMARY contact's email and mailing address will be used for all firm communications.
Primary Contact Name*

First NameMiddle NameLast Name
Primary Contact Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Contact Phone Number*
Primary Contact Phone NumberFormat: (000) 000-0000.
Date of Birth*

MonthDayYear
Primary Contact Date of Birth
Social Security Number*
Primary Contact SSN
Ownership %*
Primary Contact ownership percentage
Do you have other or additional owners of the business?

YesNo

Business Alternate Contact/Owner #2:

Please provide this alternate contact/owner's information.
Contact/Owner #2 Name*

First NameMiddle NameLast Name
Contact/Owner #2 Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Contact/Owner #2 Email Address
example@example.com
Contact Phone Number*
Contact #2 Phone NumberFormat: (000) 000-0000.
Date of Birth*

MonthDayYear
Contact #2 Date of Birth
Social Security Number*
Contact #2 SSN
Ownership %*
Contact #2 ownership percentage
Do you have other or additional owners of the business?

YesNo

Business Alternate Contact/Owner #3:

Please provide this alternate contact/owner's information.
Contact/Owner #3 Name*

First NameMiddle NameLast Name
Contact/Owner #3 Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Contact/Owner #3 Email Address
example@example.com
Contact Phone Number*
Contact #3 Phone NumberFormat: (000) 000-0000.
Date of Birth*

MonthDayYear
Contact #3 Date of Birth
Social Security Number*
Contact #3 SSN
Ownership %*
Contact #3 ownership percentage
Do you have other or additional owners of the business?

YesNo
Do you have additional owners of the business not listed here?
Please list additional owners not on this form. We will gather additional information on a separate form.

Assigned Titles for your Business

Please provide the name for each title within your business.
ASSIGNING COMPANY TITLES: Generally, officers of a Corporation/LLC run the day-to-day operations of the business. Directors/Governors serve an advisory role & help in strategic planning of the business. If your business is licensed by [Enter Your State Abbreviation Here] - Officers [Change to Will Need or Will Not Need] to be licensed as well.
President / Chief Manager*

First NameLast Name
Secretary*

First NameLast Name
Treasurer*

First NameLast Name
Director / Governor

First NameLast Name
Other Title Not Listed
Enter Name (First, Last, and Title Assigned)

Business in other States

It is VERY IMPORTANT we know if you are conducting business in other states, please review.
Do you conduct Business in other States? We would like to know if you operate in and/or do business in any state OTHER THAN the state your corporation was originally organized. Example: A Texas registered Corporation doing business in Georgia.
Do you conduct business in an additional state(s)?*

YesNoUnsure
If YES - Please list the STATE(s) and a description of your business activity
Are you registered to do business in any other state?

YesNoUnsure
If YES - Please list the STATE(s) in which you are currently registered

Company Profile Information