Perfect Form SS-4 Questionnaire

Perfect Form SS-4 Questionnaire

Please complete and e-sign the below questionnaire, and Perfect Form will then obtain your entity's EIN.
Please see the SS-4 Questionnaire Instructions page on our website if you have any questions as you complete this form. If you don't find information responsive to your question, please email us at support@perfectform.com or call us at (980) 231-0232.
1. Legal name of entity (or individual) for whom the EIN is being requested*
2. Trade name of business (if different from name in section 1)
3. Executor, administrator, trustee, “care of” name (if applicable; otherwise, leave blank)
4a. Mailing address (room, apt., suite no. and street, or P.O. box)*
4b. City, state, and ZIP code (if foreign, see instructions on our website, linked above)*
5a. Street address (if different from Mailing Address in 4a above; otherwise, leave blank) (P.O. box not permitted)
5b. City, state, and ZIP code (if different from Mailing Address in 4a above; otherwise, leave blank) (if foreign, see instructions on our website, linked above)
6. County and state where principal business is located*
7a. Name of responsible party*
7b. SSN, ITIN, or EIN of responsible party*
8a. Is this application for a limited liability company (LLC) (or a foreign equivalent)?*

YesNo
8b. If 8a is “Yes,” enter the number of LLC Members (otherwise, leave blank)*
8c. If 8a is “Yes,” was the LLC organized in the United States? (Otherwise, leave blank)*

YesNo
9a. Type of Entity (check only one box) (if an LLC: (i) if LLC has one member, select "Other" and insert "Disregarded Entity", and (ii) if LLC has multiple members, select "Partnership" or, if applicable documentation has been filed to elect corporation status, select "Corporation")*

Sole proprietor (SSN)PartnershipCorporationPersonal service corporationChurch or church-controlled organizationOther nonprofit organizationEstatePlan administratorTrustMilitary/National GuardFarmers’ cooperativeREMICState/local governmentFederal governmentIndian tribal governments/enterprisesOther (specify)
9a1. Sole proprietor's SSN (required only if entity type chosen in 9a is "Sole proprietor (SSN)"; otherwise, leave blank)
9a2. Corporation's form number to be filed (required only if entity type chosen in 9a is "Corporation"; otherwise, leave blank)
9a3. Purpose of other nonprofit organization (required only if entity type chosen in 9a is "Other nonprofit organization"; otherwise, leave blank)
9a4. SSN of decedent (required only if entity type chosen in 9a is "Estate"; otherwise, leave blank)
9a5. TIN of Plan administrator (required only if entity type chosen in 9a is "Plan administrator"; otherwise, leave blank)
9a6. TIN of Trust grantor (required only if entity type chosen in 9a is "Trust"; otherwise, leave blank)
9a7. Group Exemption Number (GEN), if any; otherwise, leave blank
9b1. Corporation's state where incorporated (required only if entity type chosen in 9a is "Corporation" and incorporation was in U.S.; otherwise, leave blank); if incorporated in foreign country, see 9b below
9b2. Corporation's foreign country where incorporated (required only if entity type chosen in 9a is "Corporation" and incorporation was in foreign country; otherwise, leave blank)
10a. Reason for applying (check only one box)*

Started new businessHired employeesCompliance with IRS withholding regulationsBanking purposeChanged type of organizationPurchased going businessCreated a trustCreated a pension planOther (specify)
10a1. Type of new business started (required only if reason for applying chosen in 10a is "Started new business"; otherwise, leave blank)
10a2. Specify banking purpose (required only if reason for applying chosen in 10a is "Banking purpose"; otherwise, leave blank)
10a3. Specify new type of organization (required only if reason for applying chosen in 10a is "Changed type of organization"; otherwise, leave blank)
10a4. Specify type of trust created (required only if reason for applying chosen in 10a is "Created a trust"; otherwise, leave blank)
10a5. Specify type of pension plan created (required only if reason for applying chosen in 10a is "Created a pension plan"; otherwise, leave blank)
11. Date business started or acquired (month, day, year)*
12. Closing month of accounting year*
13a. Highest number of agricultural employees expected in the next 12 months (enter 0 if none)*
13b. Highest number of household employees expected in the next 12 months (enter 0 if none)*
13c. Highest number of other employees expected in the next 12 months (enter 0 if none)*
14. Skip this section if 13a-c above are each 0. If you expect your employment tax liability to be $1,000 or less in a full calendar year and want to file Form 944 annually instead of Forms 941 quarterly, check box. (Your employment tax liability will generally be $1,000 or less if you expect to pay $5,000 or less, $6,536 or less if you’re in a U.S. territory, in total wages.) Note that if you don’t check this box, you must file Form 941 for every quarter.

Select if applicable
15. First date wages or annuities were paid (month, day, year). Note: If applicant is a withholding agent, enter date income will first be paid to nonresident alien (month, day, year). If not applicable, write "N/A."*
16. Check one box that best describes the principal activity of your business.*

Health care & social assistanceWholesale—agent/brokerConstructionRental & leasingTransportation & warehousingAccommodation & food serviceWholesale—otherRetailReal estateManufacturingFinance & insuranceOther (specify)
17. Indicate principal line of merchandise sold, specific construction work done, products produced, or services provided.*
18. Has the applicant entity shown on line 1 ever applied for and received an EIN?*

YesNo
If “Yes,” write previous EIN here
Does your business own a highway motor vehicle with a taxable gross weight of 55,000 pounds or more?*

YesNo
Does your business involve gambling/wagering?*

YesNo
Does your business need to file Form 720 (Quarterly Federal Excise Tax Return)?*

YesNo
Does your business sell or manufacture alcohol, tobacco, or firearms?*

YesNo
Do you have, or do you expect to have, any employees who will receive Forms W-2 in the next 12 months? (Forms W-2 require additional filings with the IRS.)*

YesNo
Third Party Designee
Designee’s name
Designee’s telephone number (include area code)

Area CodePhone Number
Designee's address and zip code
SS-4 Applicant

Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, it is true, correct, and complete.
Name, title*
Applicant's telephone number (include area code)*
Signature*

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By signing below, I hereby represent and warrant that I am authorized to apply for and receive an Employer Identification Number on behalf of the below-named entity (the "Entity"). I hereby authorize Perfect Form to apply for and receive an Employer Identification Number on my behalf for the Entity, and to answer questions about the completion of form SS-4 in connection with such application.
Name*

First NameLast Name
Email*
example@example.com
Legal Name of Entity*
Signature*

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Date*

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Should be Empty:

Perfect Form SS-4 Questionnaire

Third Party Designee

SS-4 Applicant