top of page
Business Structure 

Personal Information 

How much ownership percentage(%) do you have in the company?

Business Information 

Which busines structure plan interests you?
Which structure are you aiming to establish today?

How many individuals who own shares or are owners are part of this company?

Excluding yourself, kindly provide details regarding the other members below. If there are no additional members apart from yourself, you may proceed to the next section.

Member 1:

Ownership percentage (%):

Member 2:

Ownership percentage (%):

Member 3:

Ownership percentage (%):

Member 4:

Ownership percentage (%):

Please provide either your Social Security Number (SSN), Individual Taxpayer Identification Number (ITIN), or Employer Identification Number (EIN). However, if EMD Consortia is facilitating your EIN setup, kindly indicate "N/A" in the specified space. Note: Double check/verify your numbers before submitting this form.

Fiscal Year Close Month:

Please note that the delayed effective date should not exceed 90 days from the filing date.

How will the operations of this company be conducted?
What will be the period of duration for the company?

Registered Agent Info

Important: If EMD Consortia is designated as your registered agent, please furnish the following details: Catherine Williams, 808 Chestnut St. Ste. 33, Chattanooga, TN 37402, Hamilton County. This confirms our company's role as your representative.

Kindly inform us of your preferred approach for submitting the original documents to your company.
Upload File

Please be aware that the absence of these documents for identity verification might lead to a delay in processing your application. Nevertheless, rest assured that a representative will reach out to you via email or text to arrange a secure face-to-face verification appointment through platforms like Skype, Zoom, Messenger, FaceTime, etc., aiming to prevent any fraudulent activities.

Signatures:

bottom of page