C Corp - Entity Creation
General Information
Information about you and your new Entity (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
60-day Rollover Deadline Date (If Known)
Ex. Nov 15 (Should be 60 days after wire received)
Founder 1 Legal Name
Founder 1 SSN/TIN
xx-xxx-xxxx
Founder 1: Cash Contribution to Rollover
Ex. $8,000,000
Founder 2 Legal Name (If applicable)
If applicable
Founder 2: Cash Contribution to Rollover (If applicable)
Ex. $8,000,000
Founder 3 Legal Name (If applicable)
If applicable
Founder 3: Cash Contribution to Rollover (If applicable)
Ex. $8,000,000
Entity Creation Details
This is the information that will be used to establish your new C Corp. You will wholly control this entity. Entity names should end with either "Incorporated", "Company", or "Corporation". If not present, "Incorporated" will be added by default.
What Will be The Name of Your New Entity?
Ex. Doe Tech Incorporated
If Your First Choice is Unavailable, Option Two:
Ex. Doe Management Incorporated
If Your Second Choice is Unavailable, Option Three:
Ex. D Tech Incorporated
EIN Creation Details
This information will be used to establish an EIN for your new entity. Some fields are pre-filled for you.
Physical Address of entity (Ex. The Member's Home Address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Country
Mailing Address (If Different than Above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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
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?
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
Data Sharing & Entity Formation
I understand that my information will be reviewed by QSBS Rollover (Kuba Ventures Inc.) and shared with DBO (www.getdbo.com) for entity creation and EIN establishment. I acknowledge that I can contact DBO directly if I prefer not to use this secure form.
Consent for Document Preparation & Clerical Services
I hereby grant consent for QSBS Rollover (Kuba Ventures Inc.) to utilize the information provided in this form, as well as information received during the entity formation and EIN acquisition process, to perform clerical data entry to populate template-based documents relevant to the governance of the new corporation. This includes, but is not limited to, bylaws, board consents, share purchase agreements, and other standard corporate forms required for the initial organization of the business.
Legal Disclosure & Liability Release
I acknowledge and agree to the following: Non-Law Firm Status. QSBS Rollover (Kuba Ventures Inc.) is not a law firm and does not provide legal, tax, or professional advice; Administrative Scope. The services provided are strictly clerical and administrative in nature. QSBS Rollover (Kuba Ventures Inc.) will not modify the legal language, provisions, or "fine print" of any documents on my behalf; their role is limited to filling in data fields (e.g., names, dates, addresses) and facilitating an electronic signature process; Review & Revision. I understand that I have the opportunity, and am encouraged, to share these documents with my own legal counsel for review and revision prior to execution; Release of Liability. I release QSBS Rollover (Kuba Ventures Inc.) and its team from any and all liability related to the performance of these clerical tasks, the legal sufficiency of the templates used, or the consequences of executing these documents.
Submission & Signature
I acknowledge that the clerical preparation of documents by QSBS Rollover (Kuba Ventures Inc.) is an administrative service and does not constitute legal action or the formal adoption of corporate governance. These documents carry legal weight only once they are reviewed, approved, and fully executed by the authorized parties. Kuba Ventures Inc. assumes no responsibility for any delays, compliance lapses, or legal consequences resulting from a failure to execute or file these documents. Submission of this form, along with the electronic signature provided below, constitutes your acknowledgment of the disclosures above and grants the release of this information for the stated purposes, and no other, except with express permission from the undersigned. For questions, please contact Lauren@QSBSrollover.com.
Name of Signor
*
First Name
Last Name
Signature of Signor, Recognition of Acknowledgments
*
Please verify that you are human
*
Submit
Should be Empty: