Personal Information
Which package do you wish to purchase?
First Name
Last Name
Address
Address (additional)
City
State
Country
Billing Address
First Name
Last Name
Address
Address (additional)
City
State
Zip Code
Country
Registered Agent
Would you like Registered Agent Services for $189.00 for the 1st year (provided by our affiliate NRAI)?
Contact Name
Business Name
Address (must be a physical location within the state of formation. No Post Office Boxes accepted):
Address (continued)
City
State
Zip Code
Preferred Name of Entity
Alternative Name of Entity
Contact Person
Title
Phone Number
Email Address
Place of Business
Street Address
Street Address (continued)
City
State
Zip Code
Corporate Directors
Corporate Director #1
Address
Annual Compensation
Corporate Director #2
Address
Annual Compensation
Corporate Director #3
Address
Annual Compensation
Corporate Officers
President / CEO
Address / Phone
Annual Compensation
Secretary / COO
Address / Phone
Annual Compensation
Treasurer / CFO
Address / Phone
Annual Compensation
Vice President
Address / Phone
Annual Compensation
Other
Address / Phone
Annual Compensation
Other #2
Address / Phone
Annual Compensation
Additional Corporate Information
Date of Incorporation (leave blank if you plan to incorporate with us)(YYYY/MM/DD)
Employer Identification Number (if applicable)
Will this Non Profit Organization have any members?
If yes, what benefits do / will the members receive?
Has your organization ever filed to be a 501(c)(3) prior to this application?
If yes, please explain
Has the organization filed any tax returns as a Non Profit?
If yes, please indicate the exact numbers of returns filed and dates of filing
Describe the organization's fundraising program? Are there any available materials on the fundraising program? If yes, describe
How does the organization market and advertise itself? (i.e. mailer, magazines):
What assets does the organization have that are directly used for the purposes / functions of providing the services of the organization. If none indicate N/A
Has the organization entered into any third party contractual agreements?
If the Board Members are related, how so?
Activities & Programs
Title of Program
Brief Description
Purpose of the Program
When will the program be implemented (or when was it implemented) (YYYY/MM/DD)
List of the names of people administering the program
Where will the program be implemented? Address
Address (continued)
City
State
Zip Code:
Add another program?
Title of Program
Brief Description
Purpose of the Program
When will the program be implemented (or when was it implemented) (YYYY/MM/DD)
List of the names of people administering the program
Where will the program be implemented? Address
Address (continued)
City
State
Zip Code:
Add another program?
Title of Program
Brief Description
Purpose of the Program
When will the program be implemented (or when was it implemented) (YYYY/MM/DD)
List of the names of people administering the program
Where will the program be implemented? Address
Address (continued)
City
State
Zip Code:
Financial Information
Month the annual accounting period ends:
How does the organization finance itself?
Other, please explain
Income From Sales
1st Year
2nd Year
3rd Year
Overhead
1st Year
2nd Year
3rd Year
Expenses
1st Year
2nd Year
3rd Year
Other Income
1st Year
2nd Year
3rd Year
Salary / Wages
1st Year
2nd Year
3rd Year
Membership Dues
1st Year
2nd Year
3rd Year
Income & Donations
1st Year
2nd Year
3rd Year
Employer Identification Number
Principal Officer:
Social Security Number (xxx-xx-xxxx)
Date Business Started (YYYY/MM/DD)
Closing Month of Accounting Year
First Date Wages will be Paid (YYYY/MM/DD)
Highest Number of Employees expected in the next 12 Months
Is the Principal Business activity Manufacturing?
To Whom are Most of Your Products / Services Sold
Principal Activity
What will you be selling?
Has Applicant ever applied for EIN before?
If yes, When? City? Number?
back submit
