Business Name

Trade Name or DBA

Has this entity applied for an EIN before?

Business Physical Address (No P.O. Box)

Address

Unit, Apt

ZIP Code

State

City

Does the business has a different mailing address?

Business Activities

Reason for Applying

Products or Services

Primary Activity

Business Information

Does the business own a highway motor vehicle weighing 55,000 pounds or more?

Does the business involve gambling?

Does the business sell or manufacture alcohol, tobacco, or firearms?

Does your business pay federal excise taxes?

Do you have or expect to have an employee within 12 months, excluding owners?

Business Dates and Territory

Starting or acquiring date of business

Closing Month of Accounting Year

Owner Information

First Name

Middle Name

Last Name

Suffix

Social Security Number

Verify Social Security Number

Title

Phone Number

Contact Email

Confirm Email address