Business Formation Questionnaire

Name: MILDRID ESUA, CPA, PLLC
Price range: $

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Business Formation Questionnaire

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Entity Name and Type

Desired Name of Business – (1) *

Desired Name of Business – (2): *

Desired Name of Business – (3): *

Address: *

City *

State *

Zip Code *

Form of Business: *

LLC
C Corporation
S Corporation
Non-profit
Limited Partnership
LLP
Sole Proprietorship
Other

Other *

Registered Agent and Registered Office (All Entity Types) *

Designate SRA as the registered agent and registered office.
Designate your own registered agent and registered office. (fill out the information below)

*

A. The initial registered agent is an organization (cannot be entity named above) by the name of:
B. The initial registered agent is an individual resident of the state whose name is set forth below:

The initial registered agent is an organization (cannot be entity named above) by the name of: *

Entity or Last Name: *

First Name: *

MI: *

Suffix

business address for llc: *

City *

Zip: *

State *

Management (LLCs Only)

Will the limited liability company be managed my managers (similar to a board of directors) or by the members (the owners)? *

Managers
Members

Manager/Member/Director

Please provide the name and address of the manager, member or director of the entity:

Entity or Last Name: *

First Name: *

MI: *

DOB: *

Address: *

City: *

State *

Zip Code *

EIN/SSN: * *

Phone: *

Email: *

Title: & Ownership % *

Additional Managers/Members

N/A if no additional members or managers exist for this business

Entity or Last Name:

First Name:

MI:

DOB:

Address:

City:

State

EIN/SSN:

Phone:

Email:

Title: & Ownership %:

For additional managers/members/directors,

please add additional sheets)

The initial registered agent is an organization (cannot be entity named above) by the name of: *

The total number of shares the corporation is authorized to issue is: (1,000,000 is the default) *

A. The par value of each of the authorized shares is: *

The par value of each of the authorized shares is
The shares have no par value.

Type of Business and Purpose *

Construction
Transportation & warehousing
Retail
Real estate
Finance & insurance
Wholesale-other
Rental & leasing
Healthcare & social assistance
Other (specify)

Highest number of employees expected in the next 12 months? *

Accounting Year

Tax Matters Partner/Responsible Person

The IRS requires either an owner or person in authority (CEO or CFO)

The IRS requires either an owner or person in authority (CEO or CFO) to be the responsible person regarding applying for an employer identification number and regarding tax matters. Please identify the individual or entity who will serve this role for your company: *

Entity or Last Name: *

First Name: *

MI: *

DOB: *

Address: *

City: *

State *

Zip Code *

EIN/SSN: *

business phone number: *

business Email: *

Title: *