BOI Reporting Intake Form

Form
Corporate Transparency Act

Beneficial Ownership Information Report Questionnaire
Client Name*

First NameLast Name
Client Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Client Email*
example@example.com
Client Phone*
Please enter a valid phone number.

Beneficial Owners
If your Entity has more than four beneficial owners, please contact our office and we will make arrangements to obtain additional filing information.
Beneficial Owner 1*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Please upload a clear image that is a JPG, PNG or PDF of the Beneficial Owner's State Driver's License or United States Passport. Foreign residents can use a foreign passport. *

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Beneficial Owner 2

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Please upload a clear image that is a JPG, PNG or PDF of the Beneficial Owner's State Driver's License or United States Passport. Foreign residents can use a foreign passport.

Cancelof

Beneficial Owner 3

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Please upload a clear image that is a JPG, PNG or PDF of the Beneficial Owner's State Driver's License or United States Passport. Foreign residents can use a foreign passport.

Cancelof

Beneficial Owner 4

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Please upload a clear image that is a JPG, PNG or PDF of the Beneficial Owner's State Driver's License or United States Passport. Foreign residents can use a foreign passport.

Cancelof

Company Applicant

Company applicant reporting for existing companies: If the reporting company was created before January 1, 2024, you do not need to report any company applicant information for the reporting company. This section is only for new companies. For foreign companies the date is when it was registered in the U.S.
Company Applicant Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Please upload a clear image that is a JPG, PNG or PDF of the Company Applicant's State Driver's License or United States Passport. Foreign residents can use a foreign passport.

Cancelof

I, the Client, authorize Gregory Wright Law to file a Beneficial Ownership Information Report with FinCen on the subject entities behalf. I represent that I have authority to act on behalf of the entity in this matter.

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Payment

My Products

CTA Filing (Initial)Initial Filing for one beneficial owner

$250.00 Quantity

Additional Beneficial Owners (add one quantity per additional owner)

$75.00 Quantity

Total

$0.00

Credit Card

ACH Bank Transfer

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