FINCEN BOI INTAKE FORM

Please fill out this form to help us gather important information about your case.

Each answer on this form must be completed in full. If this form is only partially completed, we will not be able to proceed and you will need to submit the entire form again.

Do not submit answers to this form via email, social media, text messages, etc.

The answers you submit in this form are confidential.

Please email lawyer@analaw.com if you have questions about this form.

Contact information

Prefix

First name *

Middle name

Last name *

Emails

Email Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

Add email

Phone numbers

Phone number

Type

Add phone number

Point of Contact Information

Contact information

LLC Information

What is the full name of your LLC

What state is your LLC registered in?

When was your LLC formed?

Does your LLC have any trade names (alternate names, DBAs, etc.)?

What is the EIN of your LLC?

Upload a copy of your EIN letter from the IRS (if available)

LLC Address (Business Address)

Street Address (number, street, and apt. or suite no.)

City

State

Zip

Is the address a physical address?

Beneficial Owner Information

How many beneficial owners of the LLC are there?

First Name

Middle Name

Last Name

Birthday

Beneficial Owner ID

ID Type

ID Number

Upload a picture of your Passport or Drivers license (THIS IS MANDATORY)

Beneficial Owner Address (Residential Address)

Street Address (number, street, and apt. or suite no.)

City

State

Zip

Is the address a physical address?

Attorney Authorization

Are the attorneys at Ana Law LLC authorized to use your electronic signature to complete the BOI Report?

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 to complete and submit this form.

Marketing Survey

How did you hear about Ana Law?

THANK YOU