LLC INFORMATION COLLECTION FORM

JACK & ASSOCIATES LLC

600 Jefferson St

Suite 901,

Lafayette, LA, 70501

(337)278-6020
LLC INFORMATION COLLECTION FORM

The following information will provide Jack & Associates with the information needed to form the limited liability company, obtain its EIN, and draft a basic operating agreement.
Step 1: Business Details
Business Name: (Please list the desired business name exactly as you want it stated)
Your Name:

First NameLast Name
What state will your business be registered in?
Select an option for the business's physical address. (The address listed will be public record)
Business Physical Address (Fill out this section if you are using your home address or another physical address that you already have)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
With the exception of Louisiana, Jack & Associates utilizes the services of Registered Agents Inc to setup registered agent services for clients and to obtain a registered business address in all other 49 states. This process includes creating an account with them for your business and securing the first year of registered agent service. Their annual fee will be due every year on the anniversary month of the service start date. You will be able to select this service and pay the fee for the initial year in the invoice at the bottom of the form.
To preview your business's address, select the state that the LLC is being formed in:
In a few words, briefly explain the purpose or activities of the LLC:
EIN Registration

Note: The LLC will need to obtain an EIN (Employee Identification Number) once it has been formed. We will obtain it for you as part of this process. The IRS will require the owner's social security number in order to obtain the EIN. See the options below regarding your preference of providing that information.
Select an option:
Please provide your SSN# below:
Step 2: Registered Agent

The registered agent is the person or company that the owner of the business authorizes to receive legal documentation on the business's behalf for legal documents that must be served in person.
Select an option for registered agent:
Registered Agent's Name

First NameLast Name
Registered Agent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Step 3: Owner's Details
Will this business be owned by an individual(s) or by another business?
Business Partner #1
Full Name (Individual) (Please list the name of the person who will own the LLC.)(If this owner is another business entity instead of a person, list the business's name in the "First Name" section)

First NameLast Name
Name of the Parent Company
Many states, with the exception of a few, will ask for the owner's address on the filing. Do you want to use your actual address or the virtual address for this section?
Owner's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What percentage of the business do you own? (Business Partner #1)
Owner's Phone Number
Format: (000) 000-0000.
Owner's E-mail
example@example.com
Business Partner #2
Name (Business Part #2)

First NameLast Name
Business Partner #2 - Many states, with the exception of a few, will ask for the owner's address on the filing. Do you want to use your actual address or the virtual address for this section?
Address (Business Partner #2)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What percentage of the business will this partner own?
Are there any additional owners?
Business Partner #3
Name (Business Part #3)

First NameLast Name
Business Partner #3 - Many states, with the exception of a few, will ask for the owner's address on the filing. Do you want to use your actual address or the virtual address for this section?
What percentage of the business will this partner own?
How are votes for major decisions counted in the business?
How are profits and losses distributed among the partners?
Can an owner sell their shares or ownership interest to someone else?
Will the business business partners be contributing initial capital to the business?
Please list the amount of capital that each partner will be contributing: (Only answer this question if you want the amounts stated in the operating agreement)
In the event that more capital is needed for business operations or to carry out a project in the future, and not all owners can contribute while others can, specify what this will result in:
If a partner wants to leave the company, choose an option for their buyout in the event that the owners cannot agree on a buyout amount:
Select an option regarding how the exiting partner's buyout will be paid:
How did you hear about us?
Please Specify
Is there any other specific information or details that you would like us to know prior to filing?
Please list the additional details that you would like us to know below:
Step 4: Signature

Your following signature authorizes Jack & Associates LLC, and it's representative, to act as organizer for the LLC. The organizer is simply the person who files the Articles of Organization for the LLC, which legally forms and registers the entity with the state. Your signature also indicates that you agree to the terms and conditions.
Signature
Step 5: Payment

My Products

State Filing Fee

Required. This is the fee that the state charges to process LLC applications. We collect this fee here on the invoice, and then pay the fee to the state upon submission of the LLC filing.

$200.00 State

Registered Agent / Registered Business Address Service (1yr)

*Read carefully - You must select an option if you chose to obtain a registered agent and registered address during this process,

Free

Jack & Associates Fee

Fee to complete the work as discussed, which includes entity formation, obtaining the EIN number, and operating agreement.

$165.00

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Total

Should be Empty:

LLC INFORMATION COLLECTION FORM

EIN Registration

Step 2: Registered Agent

Business Partner #1

Business Partner #2

Business Partner #3

Step 4: Signature

Step 5: Payment

My Products*

My Products