LLC Worksheet

LLC Intake Form

Jen Williams International
Date*

MonthDayYear
Date
How did you hear of Jen Williams International?

I'm an Existing ClientWord of Mouth ReferralSocial MediaOnline SearchOther
If referred, who may we thank?
Referree's Name
Primary Contact's Name*

First NameLast Name
Email address for this LLC*
example@example.com
Phone Number for this LLC*

Area CodePhone Number
Proposed Name for this LLC *
Alternate Name for this LLC if preferred name is unavailable
Address for this LLC*

Street Address

Bldg, Unit, Apt, Suite etc

CityCounty (not country)

State & Zip Code
Social Security Number (to get new EIN for the LLC)*
LLC Type*

Single Member (Just you)Multiple Member (You and others)
If Multiple Members, how many? NOTE: please add $100 per extra member)
If Multiple Members, name and address of each one
MANAGERS

If Multiple Member LLC, who will be the Manager? (Type SAME if Single Member LLC)
Name

PrefixFirst NameLast NameSuffix
Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
OFFICERS

If Multiple Member LLC, please complete this section. (If Single Member LLC and you choose to be all 3 officers, type SAME. If you chose to have a non-member be an officer of your Single Member LLC, please complete this section.)
Name and address of President
Name and address of Secretary
Name and address of Treasurer
REGISTERED (STATUTORY) AGENT

A Registered Agent (also known as a Statutory Agent in some states) is only the CONTACT person or business to receive official communication, notices, court documents etc on behalf of the LLC (or corporation). This person can be ANYONE 18+ years that resides in the same state OR any legal business in the same state. The adult or business may have to agree to being appointed, such as in Arizona, but no agreement is required in Georgia. Also they must provide a physical street address. This law is mandatory in all 50 states for Registered/Statutory Agents. This person can also be you or Jen Williams International (if in AZ)
Please select your preference:*

I want to be the Registered/Statutory agentI want the resident listed below.I want the business listed below.I want Jen Williams International, LLC for my AZ LLC
Registered/Statutory Agent Name and Address
What COUNTY (not country)?
ACTIVITIES

Your LLC can engage in any legal activity of your choosing!
Please BRIEFLY explain the activities the LLC will be engaging in.*
Preferred Payment Method*

Cash AppZelleCash in person (Phoenix area only)Other
What's the username, phone number or email address for the selected payment method to send payment request?
By clicking "Submit" below, you consent to your information within this form be electronically transmitted to Jen Williams International. Once received, a file will be opened and an invoice will be sent with several payment options.

Thanks!

Jennipher Williams
Should be Empty:

LLC Intake Form

MANAGERS

OFFICERS

REGISTERED (STATUTORY) AGENT

ACTIVITIES