Corporation Tax ID (EIN) Application

Corporation Name*

Trade Name / DBA

First Name*

Middle Name

Last Name*

Social Security Number

Title*

Address*

City*

State*
Please Select an OptionAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code*

Would you like to receive mail at an address different from the Business Address? *
NoYes

What State was the Corporation Formed In?*
Please Select an OptionAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Reason for Applying*

Please Select an OptionStarted New BusinessHired EmployeesIRS ComplianceBanking PurposesChanged Type of OrganizationPurchased Business

Primary Activity*
Please Select an OptionHotel/MotelConstructionFinanceFood ServiceHealth CareInsuranceManufacturingReal EstateRental & LeasingRetailSocial AssistanceTransportationWarehousingWholesaleOther

Specific Products/Services*

Does your business own a high motor vehicle weighing 55,000 pound or more? *
NoYes

Does your business involve gambling? *
NoYes

Does your business sell or manufacture alcohol, tobacco or firearms *
NoYes

Does your business pay federal excise taxes? *
NoYes

Does your business plan to accept credit card payments? *
NoYes

Do you currently have or expect to hire employees within 12 months? *
NoYes

Date Trust Funded*

Closing Month of Accounting Year*