Small Business Startup

Please complete the following fields related to your small business.

1. Name of Company:
2. Has availability of company name been verified and/or has name been reserved with Secretary of State?

3. Address of company:

4. Type of Company:

5. Names and Addresses of Directors (please list all directors):

6. List Officers below:
residing at .
residing at .
residing at .
Vice President
residing at .
7. Names and Addresses of Shareholders (please list all shareholders):

8. To apply for an employer ID number, the SS-4 Form requries the following information:
a. Date incorporated or business begins:
b. First date wages will be paid:
c. Peak number of employees for the next 12 months:
d. Products or services sold mostly to:
e. Principal activity:
9. Name of Bank:
10. Would you like a buy/sell agreement?