Shareholder #1 (Responsible Party)Shareholder #2Shareholder #3
Last Four Digits of SSN:
Name of Your Business: Confirm designation: LLC, Limited Liability Company, Ltd., etc.
Description of Business: If retail, please indicate whether it is a storefront or online
Is this a Professional Corporation? A corporation formed by a licensed individual (such as a doctor, dentist, engineer, architect, accountant, etc.)
Board of Directors:
Number of Employees:
Date for Wages:
Expedite Through Esquire Assist: * Additional Charge
Same Day - $100Three-Hour - $300One-Hour - $1,000
Are you a Veteran or active reservist? A veteran is an individual who served in the United States Armed Forces, including a reserve component of the National Guard, and who was discharged or released from service under conditions other than dishonorable. A reservist is a member of a United States Armed Forces reserve component or National Guard.