Federal Employer Identification Number (EIN)

Company Name *

Trade Name / DBA (Optional)

Designator *

Confirm company name is exactly how filed with the state (Optional)

Number Of Members *
12345678910

Which State Was The LLC Organized In? *
—Please choose an option—Select stateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Corporation Name *

Trade Name / DBA (Optional)

Designator *

Confirm corporation name is exactly how filed with the state (Optional)

Church Organization Name *

Trade Name / DBA (Optional)

Corporation Name *

Trade Name / DBA (Optional)

Designator *

Confirm corporation name is exactly how filed with the state (Optional)

Name Of Trust *

Type Of Trust *
—Please choose an option—Select trust typeLivingTestamentaryRevocableIrrevocable

Name Of Partnership *

Trade Name / DBA (Optional)

Name Of Organization *

Trade Name / DBA (Optional)

Reason For Applying (Optional)
—Please choose an option—Select reasonStarted New BusinessHired EmployeesBanking PurposesChanged Type of OrganizationPurchased Business

Primary Activity *
—Please choose an option—Select primary business activityHotel/MotelConstructionFinanceFood ServiceHealth CareInsuranceManufacturingReal EstateRental & LeasingRetailSocial AssistanceTransportationWarehousingWholesaleOther

Specific Products/Services *

Date Business Started Or Acquired *

Street Address *

City *

State *
—Please choose an option—Select stateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code *