ATTENTION REQUIRED

NEW BUSINESS SURVEY IS MANDATORY! PLEASE FILL IT OUT IN AS MUCH DETAIL AS POSSIBLE SO THAT WE CAN READILY ASSIST YOU!

Start your New Business with ASSURANCE. Complete the survey below so that we can take the necessary steps to legally file your business. To calculate your state fees click HERE to view the fee schedule.

New Business Survey

By submitting this form, you agree to all of the terms listed in this agreement.

First Name

Middle Name

Last Name

Personal Email

Business Email

Personal Phone Number

Business Phone Number

Date Of Birth

Social Security Number

Personal Address

Business Address

If you purchased PRO, ELITE, or ELITE PRO and wish to obtain a business license, you MUST upload a copy of the front and back of your ID.

Front Of ID/DL

Back Of ID/DL

Which Entity Type Would You Like?

What Is Your Business Name?

What would be your second business name option?

Do you already have an EIN?

If the answer is yes, provide it below.

In What state are you registering your business?

Please choose the category that best describes your business.

If "Other" Describe Category Below.

Describe in detail what your business does.

Will your company have employees in the next 12 months?

How many owners does your company have?

Member 1

Personal Address

% of ownership

Member 2

Personal Address

% of ownership

Member 3

Personal Address

% of ownership

Member 4

Personal Address

% of ownership

Member 5

Personal Address

% of ownership

Billing information for State Filing Fees (Name On Card Used Must Match Name On Your Account)

Declined charges could incur a $5 fee per decline.

Billing Address

Card Number

Expiration Date

CVC/CVV

Do not sign this contract until you have received and read the information statements and notices of cancellation (No refund policy) required by state and federal law, even if otherwise advised. By signing this contract you acknowledge receipt of these disclosures prior to the time of signing and agree to the terms of this contract. You, the buyer, may cancel this contract at any time before midnight of the 3rd day after the date of the transaction. See the attached notice of cancellation for an explanation of this right below.

Today's Date

Type your FULL NAME

By checking this box and typing my name, I acknowledge that I am electronically signing my survey.

ATTENTION REQUIRED

NEW BUSINESS SURVEY IS MANDATORY! PLEASE FILL IT OUT IN AS MUCH DETAIL AS POSSIBLE SO THAT WE CAN READILY ASSIST YOU!

New Business Survey

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