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| First Alternative Name: | |
| Second Alternative Name: | |
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| This corporation will be: | For Profit
Non-Profit
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| Please list each of the stockholders of the corporation and the number of shares each will receive. |
| Stockholder: | |
| Street: | |
| City: | |
| State: | |
| Zip Code: | |
| Enter number of shares: | |
| Additional Stockholders: | |
| Please list each of the officers of the corporation. |
| President: | |
| Street: | |
| City: | |
| State: | |
| Zip Code: | |
| Social Security or Taxpayer Identification Number: |  |
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| Secretary: | |
| Street: | |
| City: | |
| State: | |
| Zip Code: | |
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| Treasurer: | |
| Street: | |
| City: | |
| State: | |
| Zip Code: | |
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| Vice President: | |
| Street: | |
| City: | |
| State: | |
| Zip Code: | |
| Which principal officer may be contacted if additional information is required? |
| Name: | |
| Title: | |
| Phone Number: | |
| Please list each of the directors of the corporation. |
| Director: | |
| Street: | |
| City: | |
| State: | |
| Zip Code: | |
| Additional Directors: | |
| Please describe the business's primary business purpose or activity. |
| Purpose/Activity description: | |
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| If someone other than EZ Online Filing will be your Registered Agent, please enter the name and address of your Registered Agent. |
| Name: | |
| Street: | |
| City: | |
| State: | |
| Zip Code: | |
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| Title: | |
| SSN/EIN of this officer: | |
| Phone Number: | |
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| Reason for Applying: | |
What is the final month of your accounting year? |
| Enter Date: | |
| Please enter the number of employees you anticipate in the next twelve months. If none, please enter a zero. |
| Number of Employees: | |
Do you expect your employment tax liability to be $1000 or less in a full calendar year? If you expect to pay $4,000 or less in total wages in a full calendar year, you can mark YES. |
| Please Select: | Yes
No
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| Please provide an estimate of the day, month and year that wages were or will be first paid. |
| Enter Date: | |
| Has the applicant ever applied for and received an EIN? |
| Please Select: | Yes
No
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| If YES, provide the previous EIN here: | |
Does your business own a vehicle with a taxable gross weight of 55,000 pounds or more? Only include vehicles that were designed to carry loads on the highway. |
| Please Select: | Yes
No
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Does your business make or sell alcohol, tobacco or firearms? |
| Please Select: | Yes
No
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Does your business need to file form 720 (Quarterly Excise tax Return)? Please note: this is not common. |
| Please Select: | Yes
No
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Will your business operate a casino, or does your business involve gambling or wagering? |
| Please Select: | Yes
No
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