nonprofit

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Name *

First

Last

Name of Nonprofit? *

Name of Registered Agent? *

Business Address *

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City

State

Zip Code

Country

Mailing Address *

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City

State

Zip Code

Country

Registered Agent Business Address? *

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City

State

Zip Code

Country

Business Phone? *

Registered Agent Phone? *

Business Email? *

Do you have a UBI #? *

Do you have an Employee Identification Number (EIN)? *

If yes please provide, if no we will file for you but need SSN of registered agent. *

Please list a minimum of three board members along with their address: *

Board Chair *

Briefly describe the organization's mission or most significant activities. *

Have your annual gross receipts exceeded $50,000 in any of the past 3 years and/or do you project that your annual gross receipts will exceed $50,000 in any of the next 3 years? *

Do you have total assets the fair market value of which is in excess of $250,000? *

Are you applying for recognition as a church, school, or hospital? *

Do you have bylaws? *

Do you already have a Certificate of Formation? *

If yes what date did you incorporate? *

Do you or will you attempt to influence legislation? *

Do you or will you pay compensation to any of your officers, directors, or trustees? *

Do you or will you donate funds to or pay expenses for individual(s)? *

Do you or will you conduct activities or provide grants or other assistance to individual(s) or organization(s) outside the United States? *

Do you or will you engage in financial transactions (for example, loans, payments, rents, etc.) with any of your officers, directors, or trustees, or any entities they own or control? *

Do you or will you have unrelated business gross income of $1,000 or more during a tax year? *

Do you or will you operate bingo or other gaming activities? *

Do you or will you provide disaster relief? *

Board Secretary *

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