Incorporating

Intake Form

Incorporating Form

1. Organizer Information

Your Name

Your Email

2. Proposed Name(s) of Organization:

Proposed Name of Organization 1

Proposed Name of Organization 2

3. Incorporator(s) Name/Address/Information

incorporator #1

incorporator #1 Address

incorporator #2

incorporator #2 Address

incorporator #3

incorporator #3 Address

incorporator #4

incorporator #4 Address

Primary Incorporator SSN

Primary Incorporator Date of Birth

Primary Incorporator Telephone

Primary Incorporator Fax

4. Business Information

Do you have a current EIN#?

If yes, please enter your EIN#

Enter Date, State and County where you applied/registered your EIN

Type of corporation

If other, specify:

Industry/Business Type

Describe your business and what services/products/programs you offer.

5. LLC Members/Organizers Name/Address (include names of partners, and/or additional organizers)

LLC Partner #1

LLC Partner #1 Address

LLC Partner #2

LLC Partner #2 Address

LLC Partner #3

LLC Partner #3 Address

6. Board of Directors Name/Address (if incorporating a 501(c)(3) lit at least 5 members with their positions.

Board of DIrectors Name/Position/Address (1 per line)

Additional Details

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