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LLC Startup Application

Is your business for profit?*

Yes

No

Is this business a professional firm? (Examples: Accounting, Law, Medicine & Surgery, Landscape Architecture, and Psychology.)*

Yes

No

Please provide 3 business name options you would like to file your business under.

List in order of preference below.

Option 1*

Most preferred

Option 2*

Option 3*

Least Preferred

Choose a designation to follow your business name:*

ORGANIZERS: All Personnel with official ownership in the company, must be at least 18 years old.

Organizer 1*

Full Name: First, Middle, Last

Address*

Address Including city and zip

Organizer 2

Full Name: First, Middle, Last

Address

Address Including city and zip

Organizer 3

Full Name: First, Middle, Last

Address

Address Including city and zip

Organizer 4

Full Name: First, Middle, Last

Address

Address Including city and zip

Organizer 5

Full Name: First, Middle, Last

Address

Address Including city and zip

Register Agent: This member will receive legal mail

Name of a member*

Full Name: First, Middle, Last

Short answer*

Mailing Address Not a PO Box (Only complete if different than address above)

Business Phone Number*

Email Address*

Broad description of business (Retail, Cleaning Service, Consulting, Personal Services, etc…)*

OPTIONAL: Please check all the groups that apply to you.

Woman

Member of a community of color

Veteran

Member of disability community

Member of immigrant community

First 5 of Social Security Number (If applying for EIN)

*By submitting this form I am authorizing Motley Business Group LLC to file for my business under the laws of my state and submit for an EIN for my company.

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