Fill out this form

for the BOI Reporting

I. Business Information

Business Name: *

Business Address: *

State *

City *

Postal code *

Business Identification Number (EIN): *Not your SSN but your EIN (Employers Identification Number)

II. Ownership Details

Beneficial Owners (List all): *

Percentage (%) of Ownership: *If you are the only owner, its 100%

Role in Business: *Owner, CEO, Manager

III. Beneficial Owner Information

Full Legal Name: No Nick Names *Include any suffix used such as III, Jr, and Sr.

Date of Birth : *

Residential Address: No PO Box or Virtual Address *

Nationality/Citizenship *

IV. Documentation

Upload Proof of Identity: File Upload/Scan and Email *

Upload your Drivers License - front side only

Business Formation Documents: *

Upload your EIN and Articles from the State

Ownership Records: *

Any member certificates, stocks, if applicable

V. Contact Information

Primary Contact Name: *

Phone Number: *

Email Address: *

VI. Filing Fee

Sell Products *

BOI Reporting

$110

VII. Declaration and Signature

Authorized Signature: *

I certify that the information provided is accurate and complete.