LLC INFORMATION COLLECTION FORM

JACK & ASSOCIATES LLC

600 Jefferson St

Suite 901,

Lafayette, LA, 70501

(337)278-6020
LLC INFORMATION COLLECTION FORM
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:

Option 1: Home Address - I will use my own residential address as the business's address.Option 2: I already have another physical address, that is not my home, that I will be using.Option 3: Registered Address - I would like to obtain a registered address from the registered agent service we discussed and use it as the business's address
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 obatin 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 obatin the EIN. See the options below regarding your preference of providing that information.
Select an option:

I will provide my ssn# here in the formI prefer not provide my ssn# in the form. Please call me later in the process to retrieve it over the phone
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:*

Option 1: Yourself - I will serve as my own registered agentOption 2: Someone Else I know - I have already selected someone other than myself to serve as registered agentOption 3: Obtain a Registered Agent - I would like to obtain a registered agent through this process
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?

This business will be own by an individual (myself)This business will be owned by multiple individuals (myself and partners)This business will be owned by another business I own (parent company)
Business Partner #1
Full Name (Individual) (Please list the name of the person who will own the LLC)*

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?

Option 1: Home Address - Select this option to list your home address on the filing for the owner's addressOption 2: Another Address I Have - Select if you already have another physical address to use, such as a virtual office address, that you already have and will useOption 3: Registered Agent Address - Select if you're obtaining the registered agent service through this process and want to use their address to keep your home address off of the filing
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*
Owner's E-mail*
example@example.com
Business Partner #2
Name

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?

Option 1: Home Address - Select this option to list your home address on the filing for the owner's addressOption 2: Another Address I Have - Select if you already have another physical address to use, such as a virtual office address, that you already have and will useOption 3: Registered Agent Address - Select if you're obtaining the registered agent service through this process and want to use their address to keep your home address off of the filing
Address (Business Partner #2)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What percentage of the business will this partner own?
How are votes for major decisions counted in the business?

In proportion to owneship percentageEqual vote, regardless of partnershipBy some other method
How are profits and losses distributed among the partners?

In proportion to ownership percentageEvenly among the owners, regardness of ownership percentageBy some other method
Can an owner sell their shares or ownership interest to someone else?

Yes, with the consent and first right of refusal of the other partner(s).Yes, with no restrictions.No
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?

YesNo
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*

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Step 5: Payment

My Products

State Filing FeeRequired. 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 FeeFee to complete the work as discussed, which includes entity formation, obtaining the EIN number, and operating agreement.

$165.00

Enter coupon

Total

$0.00

Should be Empty:

LLC INFORMATION COLLECTION FORM

EIN Registration

Step 2: Registered Agent

Business Partner #1

Business Partner #2

Step 4: Signature

Step 5: Payment