Individual

What is the full legal name of the Individual Owner? Which state is the Individual Owner a resident of? Is the Individual Owner a U.S. citizen?

LLC

What is the full legal name of the LLC? Which state is the LLC organized in? Is the LLC currently (today) in good standing? Type YOUR FULL NAME to confirm you have checked the Secretary of State's website to confirm that the LLC is in good standing. Does the LLC use any alternate name, alias, or trade name? What is the full name of the Member/Authorized Representative that has authorization to sign on behalf of the LLC? If same as Point of Contact, write "Same as POC".

Partnership

What is the full legal name of the Partnership? What state is the Partnership formed in? Does the Partnership use any alternate name, alias, or trade name? List the names and residency (state) of all related parties, including: General Partners, Active Members, and Individuals. Are all related parties citizens of the United States?

Limited Partnership

What is the full legal name of the Limited Partnership? Which state is the Limited Partnership formed in? Does the Limited Partnership use any alternate name, alias, or trade name? List the names and residency (state) of all related parties, including: General Partners, Active Members, and Individuals. Are all related parties citizens of the United States?

Corporation

What is the full legal name of the Corporation? What state is the Corporation incorporated in? Does the Corporation use any alternate name, alias, or trade name? Is the Corporation currently (today) in good standing? Type YOUR FULL NAME to confirm you have checked the Secretary of State's website to confirm that the Corporation is in good standing. What is the full name of the Member/Authorized Representative that has authorization to sign on behalf of the Corproation? If same as Point of Contact, write "Same as POC".

Joint Venture

What is the full legal name of the Joint Venture? What state is the Joint Venture formed in? Does the Joint Venture use any alternate name, alias, or trade name? List the names and residency (state) of all related parties, including: General Partners, Active Members, and Individuals. Are all related parties citizens of the United States?

Sole Proprietorship

What is the full legal name of the Proprietor? Which state is the Sole Proprietorship formed/operating in? Which state is the Proprietor a resident of? Is the Proprietor a U.S. citizen? Does the Sole Proprietorship use any alternate name, alias, or trade name?

Trust

What is the full legal name of the Trust? Which state was the Trust formed in? What is the full name of the Trustee that has authorization to sign on behalf of the Trust? Does the Trust use any alternate name, alias, or trade name?

Estate

What is the full legal name of the Estate? Which state is the Estate formed/operating in? What is the full name of the Executor that has authorization to sign on behalf of the Estate? Does the Estate use any alternate name, alias, or trade name?

Point of Contact Information

Contact information

Account Information

What is your current username @?

What is your current username URL?

What is your desired username @?

What is your desired username URL?

Do you have the trademark for your desired username?

Username Ownership Information

What type of entity is the username owner?

Username Owner Address

What is the full address of the username owner? If it is the same as the Point of Contact, write "SAME".

Is the address a physical address?

Truthfulness Confirmation

I confirm that the information I provided in this form is complete, correct, and true to my knowledge and belief.

I confirm that I have authorization (if username owner is you, your company, employer, another party, etc.) to complete and submit this form.

How did you hear about Ana Law?

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