RELEVANT BUSINESS FACTS

Entity Formation

CLIENT INFORMATION

Name

Street Address

City, State

Zip Code

E-mail Address

Phone Number

Date of Birth

COMPANY INFORMATION

Desired Name of Company

Alternative #1

Alternative #2

Business Phone

State of Organization

Business Address

City, State

Zip Code

Company Size

Entity Formation

Limited Liability Company S Corporation C Corporation Partnership Limited Partnership Limited Liability Partnership General Partner

PRINCIPAL BUSINESS ACTIVITY

Please provide a brief decription of the nature of the business. This section is intended to understand the "actual" nature of your intended business activities.

ORGANIZERS

Number of Shareholders/ Members

Name

Address

Phone Number

Social Security #

Name

Address

Phone Number

Social Security #

Name

Address

Phone Number

Social Security #

Management

Managed How?

Manager Address

Registered Agent Information

Who will receive litigation notices, subpoenas, warrants, etc?

Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number

EIN Release

Do you authorize Giampolo Law Group to obtain your Employer Identification Number (EIN)?

Trademark Application

Mark (if as a link, otherwise please send as a separate attachment to info@giampololaw.com)

Owner:

Owner address:

City:

State:

Zip code:

Phone number:

Email:

Date of first use in commerce:

If the mark is not yet in use, check here for Intent-to-Use (ITU)

ITU

Has the mark been registered for any other goods/services previously?

If so, provide the registration number (if available):

Name

First Name Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number

Area Code Phone Number

Email

example@example.com

Type of Work Seeking Registration:

Title of Work (1):

Title Type:

Type of Work Seeking Registration:

Title of Work (2):

Title Type:

Has Work(s) ever been published?

If YES, year(s) of completion/creation, date(s) of first publication and nation:

If NO, year(s) of completion/creation:

Have you preregistered your work under 17 U.S.C. 408(f)? If so, indicate preregistration number:

Name

First Name Last Name

Middle Name

Domicile:

Citizenship:

Is author's contribution a work made for hire?

Author's contribution:

Name

First Name Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Email

example@example.com

Person to be contacted regarding copyright management information or permission to use Work?

Address to send registration certificate:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

County/Parish

Copyright Registration

Author(s):

Claimant: