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Member #1 (Responsible Party) Member #2 Member #3 |
Member’s Name: |
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Address: |
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Phone: |
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Email: |
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Last Four Digits of SSN: |
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Ownership Interest: |
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Registered Agent: |
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Name of Your Business: Confirm designation: LLC, Limited Liability Company, Ltd., etc. |
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Business Address: |
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Business Phone: |
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Business Email: |
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Business Website: |
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Effective Date: |
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Description of Business: If retail, please indicate whether it is a storefront or online |
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Is this a Professional Corporation? A corporation formed by a licensed individual (such as a doctor, dentist, engineer, architect, accountant, etc.) |
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Managed By: |
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Officers: |
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Employees: |
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Entity Tax Designation: “Default” is automatically treated as a partnership unless elected otherwise |
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Bank: |
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Accountant: |
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Insurance Agent: |
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Referred By: |
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Expedite Through Esquire Assist: * Additional Charge |
Expedited Service:
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