CTA Beneficial Ownership Reporting Submitted

Thank you for allowing Evans & Davis to assist in your Beneficial Ownership Reporting to FinCen.

The following information is the information we will need to submit the report on your behalf.

1.Do you agree to this contract with Evans & Davis? (Required.)

Yes

No

View Contract Here

2.Your Business Name(Required.)

3.Alternate names through which your business operates under (Registered with the state or DBA)

4.Business Address(Required.)

Street

City

State

Postal Code

5.State Where Business is Located(Required.)

6.FEIN/EIN of Business(Required.)

7.Owner #1's Information (Over 25% ownership)(Required.)

Full Legal Name

Date of Birth

Current Address

City/Town

State/Province

ZIP/Postal Code

Drivers License Number

Email Address

8.What Percentage of the Business does Owner #1 own?(Required.)

9.Upload Owner #1's Driver's License, State ID or Passport(Required.)

File Size Limit 4MB

No file chosen

10.Owner #2's Information (If owns more than 25% ownership)

Full Legal Name

Date of Birth

Current Address

City/Town

State/Province

ZIP/Postal Code

Drivers License Number

Email Address

11.What Percentage of the Business does Owner #2 own?

12.Upload Owner #2's Driver's License, State ID or Passport

File Size Limit 4MB

No file chosen

13.Owner #3's Information (If owns more than 25% ownership)

Full Legal Name

Date of Birth

Current Address

City/Town

State/Province

ZIP/Postal Code

Drivers License Number

Email Address

14.What Percentage of the Business does Owner #3 own?

15.Upload Owner#3's Driver's License, State ID or Passport

File Size Limit 4MB

No file chosen

16.Owner #4's Information (If owns more than 25% ownership)

Full Legal Name

Date of Birth

Current Address

City/Town

State/Province

ZIP/Postal Code

Drivers License Number

Email Address

17.What Percentage of the Business does Owner #4 own?

18.Upload Owner #4's Driver's License, State ID or Passport

File Size Limit 4MB

No file chosen

19.Please list any Managers who exercise substantial control of the business, but are less than 25% Owners.
Manager #1's Information

Full Legal Name

Date of Birth

Current Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Drivers License Number

Email Address

20.Upload Manager #1's Driver's License, State ID or Passport

File Size Limit 4MB

No file chosen

21.Please list any Managers who exercise substantial control of the business, but are less than 25% Owners.
Manager #2's Information

Full Legal Name

Date of Birth

Current Address

City/Town

State/Province

ZIP/Postal Code

Drivers License Number

Email Address

22.Upload Manager #2's Driver's License, State ID or Passport

File Size Limit 4MB

No file chosen

23.Please list any Managers who exercise substantial control of the business, but are less than 25% Owners.
Manager #3's Information

Full Legal Name

Date of Birth

Current Address

City/Town

State/Province

ZIP/Postal Code

Drivers License Number

Email Address

24.Upload Manager #3's Driver's License, State ID or Passport

File Size Limit 4MB

No file chosen

25.Did Evans & Davis draft your Operating Agreement?

Yes

No

26.If Evans & Davis did not draft your Operating Agreement, please click here to upload it.

No file chosen

Please click here to remit payment via credit card, debit card or check information.
In the Client Account Section - Insert 0 (Zero)

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Corporate Transparency Act - Beneficial Ownership Reporting