EmailMe Form - New Company Registration

Company Name(s) *
Please write down from 1 to 3 possible company names. eg: Lopez Painting Services
Shareholder #1 - Full Name *
First Middle Last
Legal First, Middle, and Last Name
Shareholder #1 -Personal Identification Number
123-45-6789
SSN/ITIN
Shareholder #1 - Date of Birth *
01/01/1990
Email *

Confirm
Phone *
### - ### - ####

Confirm
### - ### - ####
Mailing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Registrations *
Company Renewal
EIN Number
FL State Registration
Resale Tax Certificate FL (Optional) + $150.00
If you resale products to end users you are required to have a Resale Tax Certificate.
Description of the Business *
Type of Business, Industry, type of Clients
Additional Shareholders
Any Additional Shareholders/Partners to the Business Above
Full Name
First Middle Last
Legal First, Middle, and Last Name
Date of Birth
01/01/1990
Personal Identification Number
123-45-6789
SSN/ITIN
Email

Confirm
Phone
### - ### - ####

Confirm
### - ### - ####
Full Name
First Middle Last
Legal First, Middle, and Last Name
Date of Birth
01/01/1990
Personal Identification Number
123-45-6789
SSN/ITIN
Email

Confirm
Phone
### - ### - ####

Confirm
### - ### - ####
Terms and Agreement *
All the information provided above is true and correct, and I allow Neuer Horizon to use it to provide the proposed services.