Partner Onboarding and Entity Creation Information
General Information
Information about the principal agent of your new C Corp (Your info!)
Name as it Should Appear on Legal/Entity Documents
First Name
Middle Name
Last Name
DOB
-
Month
-
Day
Year
Date
Business Contact Email
example@example.com
Phone Number
Format: (000) 000-0000.
US Citizenship Status
Please Select
US Citizen
Permanent Resident
Non-Resident
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Front and Back of US Photo ID (DL, Passport, US State ID, etc.)
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LLC/C Corp Creation Details
This is the information that will be used to establish your new C Corp. This is the entity that you will wholly own and control - the one that will issue your new QSBS stock.
What Will Be The Name of Your New C Corp?
Example: Doe Merchant Management, LLC
If the Above Name is Unavailable, Second Choice:
Example: Doe Merchant Trading Management, LLC
I Authorize The Entity to be Formed in the State of Delaware
Yes
No
I Authorize DBO (www.getdbo.com), (our Corporate Services Partner) to Act as the Entity's Registered Agent in Delaware
Yes
No
EIN Creation Details
This information will be used to establish an EIN for your new entity. Some fields are pre-filled for you.
I Acknowledge That The Trade Name of This Entity Will Be The Same as It's Legal Name Above
Yes
No
I Acknowledge That The Entity Is a Single-Member Entity
Yes
No
Physical Address of entity (Ex. The Member's Home Address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County
Mailing Address (If Different than Above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Responsible Party SSN
XXX-XX-XXXX | This information will be redacted on transmission and communicated over the phone to DBO.
Principal Business Activity
Holding company
Principal Line of Merchandise Sold or Specific Services Provided
Holding company
Reason for Applying for EIN
Starting a new business
Closing Month of Accounting Year
Example: January
Will the Entity Have W2 Employees?
Yes
No
Does your business own a highway motor vehicle with ataxable gross weight of 55,000 pounds or more?
Yes
No
Does your business involve gambling/wagering?
Yes
No
Does your business need to file Form 720(Quarterly Federal Excise Tax Return)?
Yes
No
Does your business sell or manufacture alcohol, tobacco, or firearms? (For the purpose of this form, this entity does not engage in this business, a subsidiary will.)
Yes
No
Do you have, or do you expect to have, any employees who will receive Forms W-2 in the next 12 months?
Yes
No
Month/Year wages will first be paid:
Will employment tax liability be $1000 or less in a full calendar year?
Has the applicant entity shown above ever applied for and received an EIN?
Yes
No
Amount of Money That Will Be Contributed to Fund the Above Entity:
Total Rollover Amount, Example: $1,000,000
Name of Bank That Will Be Used for the Entity
We recommend Mercury (www.mercury.com) for expedience, but this is up to partner discretion.
Partnership Information
Information pertaining to your contribution to the partnership (joint venture). Your new C Corp will be a 98.5% partner in this new Joint Venture.
Amount of Money That Will Be Contributed to Fund the Joint Venture From the Above Entity:
Total Inventory Contribution Amount from Entity, Example: $850,000, must be a sum of at least 80% of the above Entity contribution value.
Sharing of Information and Acknowledgments
I understand that the above information will be reviewed by managers of QSBSrollover.com and shared with the Corporate Services Firm, DBO (www.getdbo.com) for entity filing, registered agent establishment, operating agreement completion, and other relevant filings for entity creation and EIN establishment. I also acknowledge that if I am not comfortable providing the above information via this secure form, I can contact DBO directly to provide these details. Submission of this form along with the electronic signature provided below grants the release of this information for the above stated purposes, and no other, except with permission from the undersigned. For questions please contact Brady@QSBSrollover.com.
Name of Signor
*
First Name
Last Name
Signature of Signor, Recognition of Acknowledgments
*
Please verify that you are human
*
Submit
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