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
1-10 employees
10-50 employees
50-100 employees
over 100 employees
Entity Formation
Limited Liability Company
S Corporation
C Corporation
Partnership
Limited Partnership
Limited Liability Partnership
General Partner
Other
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?
Member Managed
Manager Managed
Choice 2
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
Phone Number
EIN Release
Do you authorize Giampolo Law Group to obtain your Employer Identification Number (EIN)?
Yes
No
Trademark Application
Mark (if as a link, otherwise please send as a separate attachment to info@giampololaw.com)
Owner:
Owner address:
City:
State:
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
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):
Copyright Registration
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Type of Work Seeking Registration:
Literary Work
Work of the Visual Arts
Sound Recording
Work of the Performing Arts
Motion Picture/ Audio Visual Work
Single Serial Issue
Title of Work (1):
Title Type:
Title of Work Being Registered
Previous or Alternate Title
Title of Larger Work
Series Title
Contents Title
Type of Work Seeking Registration:
Literary Work
Work of the Visual Arts
Sound Recording
Work of the Performing Arts
Motion Picture/ Audio Visual Work
Single Serial Issue
Title of Work (2):
Title Type:
Title of Work Being Registered
Previous or Alternate Title
Title of Larger Work
Series Title
Contents Title
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:
Author(s):
Name
First Name
Last Name
Middle Name
Domicile:
Citizenship:
Is author's contribution a work made for hire?
Author's contribution:
Photograph
2-D artwork
Jewelry Design
Sculpture
Map
Architectural work
Technical drawings
Claimant:
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County/Parish
Submit
Should be Empty: