Business Entity Application Form

BUSINESS ENTITY APPLICATION FORM

This Business Entity Application Form ("Application") is submitted by the undersigned for the purpose of registering and authorizing the business activities described herein and for establishing the terms under which the Applicant will be accepted and processed. Applicant certifies that all information provided is true, accurate and complete.

WHEREAS

WHEREAS, Applicant seeks registration and recognition as a business entity for the operation of lawful business activities described in this Application; and

WHEREAS, the receiving Authority or Registrar requires submission of identifying, organizational, ownership, and fee information to evaluate and process the Application; and

WHEREAS, upon acceptance, Applicant agrees to comply with applicable rules, pay required fees, and be bound by the terms contained in this Application and any resulting registration or approval instrument.

ENTITY INFORMATION

Entity Legal Name:

Corporation LLC Partnership Sole Proprietorship Other:

Formation Date (MM/DD/YYYY):   Jurisdiction of Formation:

CONTACT PERSON

SCOPE OF BUSINESS / SCOPE OF WORK

Provide a concise but complete description of the business activities, services, products, and operational scope for which registration is sought.

OWNERS / OFFICERS

Provide names, titles, and ownership percentages for principal owners or officers. Attach separate sheet if necessary.

PAYMENT TERMS

Application Fee Amount:

Late Fee and Interest:

TERM AND TERMINATION

Term Commencement Date:   Term Expiration Date (if any):

Either party may terminate this Application/Agreement upon written notice delivered not fewer than days prior to termination. Termination does not relieve Applicant of obligations incurred prior to the effective date of termination, including payment obligations.

CONFIDENTIALITY

Applicant shall designate any materials submitted with this Application that Applicant reasonably believes are proprietary or confidential. All designated confidential information shall be treated as confidential by the receiving Authority to the extent permitted by applicable law. Notwithstanding the foregoing, information that is required by law to be disclosed or that is in the public domain shall not be treated as confidential. Applicant warrants that no submitted information breaches third-party confidentiality obligations.

GOVERNING LAW

This Application and any resulting registration, approval, or agreement shall be governed by and construed in accordance with the laws of the state of formation or the jurisdiction specified by the receiving Authority, without regard to principles of conflicts of law. Applicant consents to the exclusive jurisdiction of courts of competent authority for disputes arising from this Application.

ENTIRE AGREEMENT

This Application, including all attachments, schedules, and written communications expressly incorporated herein, constitutes the entire agreement between Applicant and the receiving Authority concerning the subject matter hereof and supersedes all prior or contemporaneous understandings and agreements. Any amendment must be in writing and signed by authorized representatives of both parties.

CERTIFICATIONS AND ACKNOWLEDGEMENTS

By signing below, Applicant certifies under penalty of perjury that all information in this Application is true, complete, and correct to the best of Applicant's knowledge; that Applicant is authorized to execute this Application on behalf of the Entity; and that Applicant understands that false statements may result in denial, revocation, or other penalties as provided by law.

Required attachments (check applicable):
Formation documents / articles of organization/incorporation
Operating agreement / bylaws
EIN confirmation
Ownership / officer documentation

ADDITIONAL INFORMATION

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