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Beneficial Ownership Information Report

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State of Initial Formation/Jurisdiction:

Enter the State your entity is formed in. If your entity is formed as a domestic entity in one state, and as a foreign entity in multiple other states, please only select the state of domestic registration. If your entity is registered domestically in multiple states, you must complete a separate application for domestic registration. If your entity was only domestically registered outside of the Unites States, please select “Outside of the USA”.

DBA/Trade Names:

If your entity operates under any DBAs, Trade Names, or Assumed Names, please list each one here. If not, skip this question.

Main Place of Business*

Enter the Street Address of your entity’s main place of business. PO Boxes are not allowed.

Does the company have any partner other than you who owns more than 25% of the shares?
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