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LOGIN INFORMATION
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Email*:
Password*:
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State*:
Type of Entity*:
 
ORDER INFORMATION
Do you want to apply for EIN? Yes No
EIN:
Infotax Square and State Fees for EIN : $
Standard State Filing Fee: $
Infotax Square Fee for Employment WithHolding Tax: $
Shipping and Handling: $
Total: $
Reseller Discount: $
Total: $
CONTACT INFORMATION (This is where we will ship your documents)
First Name*:
Last Name*:
Address*:
Suite/Apt:
City*:
State*:
Zip*:  (99999) OR (99999-9999)
Phone*:
Fax:
 
BUSINESS OVERVIEW
Is it a new business? Yes No
Name of Entity*:
DBA/Trade Name (if any):
State of Formation*:
Date of Formation*:  (mm/dd/yyyy)
Date Business Planning to Start*:
it can be a future date (mm/dd/yyyy)
Estimated Monthly Gross Receipts/Sales*:
Copy Address from Contact Information if same
Address*:
(P O BOX address is not acceptable)
Suite/Apt:
City*:
State*:
Zip*:  (99999) OR (99999-9999)
Business Type:
Business Description*:
 
OFFICERS/MEMBERS INFORMATION
OFFICER 1
  Same as Contact Information
Full Name*:
Title*:
Driving License Number: (if any)
Social Security Number*: (999-99-9999)
Percentage of Ownership*:
Date of Birth*:  (mm/dd/yyyy)
Residence Address*:
City*:
State*:
Zip*:  (99999) OR (99999-9999)
Phone:
Fax:
OFFICER 2 
Full Name:
Title:
Driving License Number: (if any)
Social Security Number: (999-99-9999)
Percentage of Ownership:
Date of Birth:  (mm/dd/yyyy)
Residence Address:
City:
State:
Zip:  (99999) OR (99999-9999)
Phone:
Fax:
OFFICER 3 
Full Name:
Title:
Driving License Number: (if any)
Social Security Number: (999-99-9999)
Percentage of Ownership:
Date of Birth:  (mm/dd/yyyy)
Residence Address:
City:
State:
Zip:  (99999) OR (99999-9999)
Phone:
Fax:
PAYMENT INFORMATION
  Same as Contact Information
First Name*:
Last Name*:
Billing Address*:
City*:
State*:
Zip*:  (99999) OR (99999-9999)
Phone*:
Fax:
Card Type*:
Expiration Date*:
Card Number*:
Card Security Code*:
Please use the security code as follow:

1. Master Card- Please insert 3 digits security code from the back of the card
2. Visa Card- Please insert 3 digits security code from the back of the card
3. Discover Card- Please insert 3 digits security code from the back of the card
4. American Express- Please insert 4 digits security code from the front of American Express

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