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Business Information
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Tax ID Number (EIN)
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Business Activity / What the company does:
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Business Address
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Information of Signing Member / Owner
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Date of Birth
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Social Security Number (SSN)
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Phone Number:
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Email Address
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Mailing Address
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Zip Code
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Owner / Partner Information
Please complete if there has been a CHANGE IN OWNERSHIP / Partners.
Other Owners / Partners
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Last
Entity Type
Tax ID Number / SSN
Address
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Address Line 2
City
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Maryland
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Additional partners
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Information losses)? Information
Business Credits
List applicable business tax credits:
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Have you been audited in the past?
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Any carryover amounts (e.g., capital losses)?
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Direct Deposit Information (Optional)
This is required to recieve any refunds per Executive Order 14247. If you do not provide this information, you will receive a notice from the IRC (Form CP53E) demanding bank information or an explanation why you require a physical check, BEFORE a refund is issued.
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