Nonprofit Limited Liability Company

Contact Information

Name

First Last

Email*

Enter Email Confirm Email

Phone*

Name of Limited Liability Company

Please provide 3 choices for the name, in order of preference, so in the event your preferred choice is not available we can proceed with your next choice. The company name must include the words Limited Liability Company or the abbreviation LLC.

1st Choice*

2nd Choice

3rd Choice

Registered Office Address and Agent

Address has to be a physical address not a PO Box.

Street Address Address Line 2 City State ZIP Code

Registered Agent at the above address is:

First Last

Organizers

Organizer's Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Organizer's Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Email Address for Official Notices

Exclude Email

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Name of person that can be contacted about this form

First Last

Phone number of person that can be contacted about this form

How many Minnesota – based full time employees (or FTE equivalents) does this entity currently have?

0-5
6-50
51-200
201-500
over 500

Does the owner or a member of the ownership group of this entity self-identify as a member of any of thefollowing communities?

Woman
Member of a community of color
Veteran
Member of a disability community
Member of an immigrant community

Using NAICS codes below, please select the code that best describes this entity. If you believe this entity fallsinto more than one category, please select the category that generates the majority of the entity’s revenue.

Is this entity a full time or part time endeavor for those primarily responsible for operating this entity?

Full time
Part time

If applicable, what were this entity's gross revenues for the past year?

$0 - $10,000
$10,001 - $50,000
$50,001 - $250,000
$250,001 - $1M
Over $1M

Application Fee

Price:

Please select an additional service that you wish to have processed

Priority Request / Rush Processing + $75

Total

$0.00

Consent

I agree

I CERTIFY THAT THE RECITATIONS CONCERNING THE VESSEL: NAME, TONNAGE, DIMENSIONS, PROPULSION, OWNERSHIP, HAILING PORT, RESTRICTIONS, ENTITLEMENTS, REMARKS AND ENDORSEMENTS CONTAINED IN THE CERTIFICATE OF DOCUMENTATION REMAIN ABSOLUTELY THE SAME.

NAME:*

Type your full name to sign this secure webform

Signature*

CAPACITY OF PERSON SIGNING (E.G., AGENT, TRUSTEE, GENERAL PARTNER, CORPORATE OFFICER, MEMBER)

Authorization*

I agree

I agree to pay the above total amount according to the card issuer agreement and hereby authorize the charge for the total amount above for the processing of selected applications. I understand that my application will be processed in the order in which it is received by Corporation Center, a private fee-for-service company, not owned or operated by any governmental agency. I understand that application and processing fees are non-refundable as per Corporation Center’s no refund policy.

Credit Card

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