BOI Intake Form

Business Information

What is the full legal name of your business? *

What is your business's address (including city, state, and ZIP code)? *

What is your business’s EIN (Employer Identification Number)? *

What is the business's formation date?* *

Drivers License and Social Security Card (each owner) *

IRS letter of election for Partnerships and Corporations *

Ownership Details

Please list all individuals who own 25% or more of the business (full name, percentage of ownership, date of birth). *

For each owner, please provide the address, social security number (or other identifier), and contact information. *

Are there any entities that hold 25% or more ownership in the business? If yes, please list entity names, addresses, EINs, and ownership percentage. *

Control Information

Who holds executive control positions within the business? (e.g., CEO, CFO, President) *

For each control individual, please provide full name, title, address, and social security number (or other identifier). *

Business Structure

What is your business’s legal structure? (e.g., LLC, Corporation, Partnership) *

Are there any parent or subsidiary companies? If yes, please list their names, EINs, and relationship to the business. *

Certification & Documentation

Does your business have a Certificate of Good Standing?

Are there additional documents confirming business ownership? (e.g., Shareholder Agreements, Articles of Incorporation)

Contact Information for Submission and Follow-Up

Please provide the contact details of the primary person responsible for the BOI report submission. (name, phone, email) *

Additional Information

Are there any recent or anticipated changes to ownership or control that the report should reflect? *

Are there any other notes or special instructions we should be aware of for completing the report? *

Collect Payment *

Partnership & Corporations

$250

One Member LLC

$100

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