LLC Formation Intake Form

Please complete every section as fully as possible. The details you provide are used to prepare your LLC formation paperwork and keep your filing accurate. If a question does not apply, enter “N/A.”

CodeVerse360 is not a law firm and this form does not constitute legal, tax, or financial advice. We recommend consulting a licensed attorney or accountant for guidance specific to your situation.

1. Requesting Party / Client Information

Full Legal Name

Company / Brand Name (if different)

Email Address

Phone Number

Best Time to Reach You

Preferred Contact Method

Preferred Language for Communication

2. Proposed LLC Details

Desired LLC Name – 1st Choice

Desired LLC Name – 2nd Choice (backup)

Desired LLC Name – 3rd Choice (backup)

DBA / Trade Name

State of Formation

Industry / NAICS Code (if known)

Principal Business Address

Mailing Address (if different)

Business Purpose / Primary Activity

New LLC, or Converting an Existing Business?

Requested Effective Date

Leave blank for immediate filing.

Will the LLC do business in other states? If yes, list which.

3. Ownership & Management Structure

Management Structure

Number of Members / Owners

Desired Federal Tax Classification

Members / Owners

List each member or owner below. If there are more than three, provide the remaining details in Additional Notes.

Member / Owner 1

Name

Address

Ownership %

Title / Role

Member / Owner 2

Name

Address

Ownership %

Title / Role

Member / Owner 3

Name

Address

Ownership %

Title / Role

4. Registered Agent

Registered Agent

Registered Agent Name (if self-provided)

Registered Agent Address (if self-provided)

A registered agent must have a physical street address, not a P.O. box, in the state of formation and be available during normal business hours to receive legal documents. CodeVerse360 can serve as your registered agent if you don't already have one.

5. Additional Services Needed

Select Yes or No for each service.

EIN (Federal Tax ID) Application

Operating Agreement Drafting

Business Bank Account Setup Assistance

State / Local Business License Research

Business Website / Domain (CodeVerse360)

Desired Domain Name (if a website is needed)

Filing Preference

Other (please specify)

Federal reporting note: Under FinCEN's current rule, U.S. domestic LLCs are generally exempt from Beneficial Ownership Information (BOI) reporting. Only foreign entities registering to do business in the U.S. must generally file. Requirements can change, and CodeVerse360 will flag it if relevant.

6. Timeline & Additional Notes

Desired Filing Timeline / Deadline

Additional Notes / Special Instructions

7. Client Acknowledgment

By signing below, I confirm that the information provided in this form is accurate to the best of my knowledge and I authorize CodeVerse360 to use it to prepare my LLC formation documents.

For multi-member LLCs: the signature below authorizes CodeVerse360 to proceed on the group's behalf. Each additional member should confirm their listed ownership details with CodeVerse360 directly, or a multi-signer version of this form is available on request.

Signature (type full name)

Date

I confirm that the information I have provided is accurate and I authorize CodeVerse360 to use it for preparation of my LLC formation documents.

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