1. Contact Information

E-mail: contactemail Phone: Contact Phone Other Phone: contactotherphone

2. Name of Company

If no use this: llcaddress, llccity, llcstate  llczip

County: llccounty State if other: llcother

Phone:llcphone Fax:llcfax

Business Purpose:

businesspurpose

3. Management Structure of the LLC and Member Information

llcmanagement

The members of an LLC are its owners. Only one member is required. You provided the member information below. 

Member #1 Same As Contact Person in #1?

Member 1 same as contact

Member #1 Contribution Amount:

Member 1 Contribution

Member #1 Contribution Date:

Mem 1 Monthofcontrib. Mem 1 Date Mem 1 Year

Member #1 % of interest in the LLC:

Mem 1 % of interest

Member #1 Contact Information if different than main contact person:

Name:Member1name Member 1 Last Name

Address:Member 1 Address, Member 1 City, Member 1 State

Member 1 Zip If Other:otherstate

Member #2 Information:

Member #2 Contribution Amount:

Member 2 Cont.

Member #2 Contribution Date:

Mem 2 Month Mem 2 Date Mem 2 Year

Member #2 % of interest in the LLC:

Member 2 interest

Member #2 Contact Information:

Name:Member 2 Name Member 2 Last name

Address:Member 2 Address, Member 2 City, Member 2 State

Member 2 Zip If Other:Member 2 other state

Member #3 Information:

Member #3Contribution Amount:

Member 3 Contribution

Member #3 Contribution Date:

Member 3 month Member 3 date Mem 3 Year

Member #3 % of interest in the LLC:Member 3 interest

Member #3 Contact Information:

Name:Member 3 Name Member 3 last name

Address:Member 3 address, Member 3 City, Member 3 State

Member 3 Zip If Other:Other1

4. Registered Agent Information

A registered agent is a person or company designated to receive mail, notices and service of process for your LLC. Every state requires the appointment of a registered agent and most people serve as their own agent. The agent does not have to be affiliated with your company but must have a physical address in the state of formation. Because most people serve as their own agent, these services are not included in our package price. If you need to hire a company to provide this service, SouthernFilings can arrange this for you. This will add $135.00 to your package price. You will be asked to add this service to your order total upon completion.

Do you need SouthernFilings.com to arrange for Registered Agent services for $135 for the first year?

llcraservices

If no, registered agent contact information:

RAname Lname Use Contact Information? usecontactinformationRA Address RA City RA County RA State RA Zip

5. Federal Identification Number (FEIN) Information

Assistance obtaining a Federal Employer Identification Number (FEIN) is included in all our packages.

You selected:

feinconsent

Principal's Name:

principalname

Principal's SSN:

principalssn

Business was previously:

previousentity previousstatus

Will this business have employees?

llcemployees

If so how many?

estimatedemployees

What is the closing month of your accounting year?

llcclosingmonth

When do you estimate paying wages?

wagesdate

Have you ever applied for a FEIN?

llcpreviousfein

If yes, the number was previousfein and it was in

prevfeincity, prevfeinstate

Name of previous business:

nameofpreviousbusiness

6. Special Instructions And Acceptance of SouthernFilings.com Terms & Conditions

I accept the SouthernFilings.com Terms and Conditions: terms