USA EIN Registration
Registration Order Date:
Person Ordering the Registration:
Email address
Legal name of entity for whom the EIN is being requested:
Executor, administrator, trustee, “care of” name:
Mailing address (room, apt., suite no. and street, or P.O. box)
City, state, and ZIP code
Street address (if different) (Do not enter a P.O. box.)
City, state, and ZIP code
County and state where principal business is located
Name of principal officer, general partner, grantor, owner, or trustor
SSN, ITIN, or EIN
Is this application for a limited liability company (LLC) (or
a foreign equivalent)?
Yes
No
If “Yes,” enter the number of
LLC members
If “Yes,” was the LLC organized in the United States?
Yes
No
Type of Entity
If Sole Proprietorship, Please Enter SSN
If Partnership, Please Enter SSN
If Corporation,(enter form number to be filed)
Is this a Personal Service Corporation?
Yes
No
Is this a Church?
Yes
No
Is this a nonprofit organization?
Yes
No
Is this other type of organization??
Yes
No
If other type of organization, please specify
If Estate (SSN of decedent)
If Plan administrator (TIN)
If Trust (TIN of grantor)
If a corporation, name the state or foreign country
(if applicable) where incorporated
If a corporation, State?
If a corporation, Country?
Reason For Applying
Starting a new business. Please specify type of business:
Started new business. Please specify type of business:
Hired employees. Highest number of Agricultural employees expected in the next 12 months (enter -0- if none).:
Hired employees. Highest number of Household employees expected in the next 12 months (enter -0- if none).:
Hired employees. Highest number of Other type of employees expected in the next 12 months (enter -0- if none).:
Reason for Applying: Compliance with IRS withholding regulations
Yes
No
Do you expect your employment tax liability to be $1,000
or less in a full calendar year?
Yes
No
First date wages or annuities were paid (month, day, year). Note. If applicant is a withholding agent, enter date income will first be paid to
nonresident alien (month, day, year):
Reason for Applying, other (specify):
Reason for Applying, Banking purpose (specify purpose):
Reason for Applying, Changed type of organization (specify new type):
Reason for Applying: Purchase going business
Yes
No
Reason for Applying, Created a trust (specify type):
Reason for Applying, Created a pension plan (specif y type)
Date business started or acquired (month, day, year):
Closing month of accounting year:
Check select the category that best describes the principal activity of your business.
Construction
Real Estate
Rental and Leasing
Manufacturing
Transportation and warehousing
Finance and Insurance
Health care & social assistance
Accommodation & food service
Other
Wholesale-agent/broker
Wholesale-other
Retail
Indicate principal line of merchandise sold, specific construction work done, products produced, or services provided.:
Has the applicant entity shown on line 1 ever applied for and received an EIN?, If “Yes,” write previous EIN:
Applicant Information
Name:
Last Name:
Address:
City:
State:
Zip Code:
Phone Number:
Fax Number:
Your Credit Card Billing Information
Type of Credit Card:
Visa
Mastercard
AMEX
Credit Card Holder Name:
Credit Card Number:
Credit Card Expiration Number:
Credit Card 3 Digit Verification Number:
(the 3 digit verification numbers are the 3 numbers located inside of a square, in the back on your credit card, next to the signature box
Credit Card Billing Address:
Credit Card Billing City:
Credit Card Billing Province/State:
Credit Card Billing Postal Code/Zip Code:
Credit Card Billing Country:
Credit Card Billing Phone Number:
Additional information
How do you hear about us:
Google
Yahoo
MSN
Craiglist
Kijiji
BackPage
Other Search Engine
Link from another web site
Word of mouth
Print Advertising
If other search engine which one?:
If Link from another web site which one?:
If print advertising which one?:
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