Questionairre

Company Information

Company Legal Name (include punctuation):

DBA Name (if applicable):

FEIN:

Business Description and Activity:

NAICS Code:

State of Formation:

Date Formed:

How is the company taxed for Federal income tax purposes? (i.e., LLC, C- Corp, S-Corp, Partnership):

Who manages the LLC (if applicable):

Fiscal Year End Date:

California Secretary of State Number (if applicable):

Physical Location of mailing

Street Address

City

State

Zip Code

Country

Mailing Address (If Different):

Street Address

City

State

Zip Code

Country

Contact Person

Name

Title

Phone

Fax

First Date Company Will Make A Sale And Collect Sales Tax

Bank Account Information (Some Permits Require A One Time Nominal Fee)

Bank Account Name

Routing Number

Account Number

Supplier Information (if applicable)

Supplier Name

Supplier Street Address

Supplier City

Supplier State

Supplier Zip

Supplier Country

Supplier Phone

Registered Agent (only needed if applying for KY Secretary of State)

Name:

Street Address:

City:

State:

Zip:

Corporate Officer

Name

Title

Start Date

Address

City

State

Zip

Country

Photo ID (Driver’s License or Passport)*

What State (DL) or Country (Passport) Issued the ID?

Date of Birth

SSN or ITIN

Telephone Number

Email Address

Percent Ownership (%)

Instructions