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We need some information to set up your account. We use this secure form to make sure we cover everything and sensitive information is not being transmitted via email. If a field does not apply, please just enter “N/A.”

Your Name (does not have to be the company-owner's name)

First Name

Last Name

Phone (can be a cell phone; whatever you want us to use to contact you)

(###)

###

####

Official Company Name (on file w/ IRS)

DBA Name (if applicable)

Company Entity Type

EIN

If the company is operating as a sole-proprietorship under the owner's SSN then enter it instead of an EIN)

Company Start Date or Incorporation Date

Official Company Address (on file with the IRS)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mailing Address (if different from address) above))

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Company-owner's Name

First Name

Last Name

Is the owner listed above the 100% sole owner of the company?

If you indicated that there are multiple owners above, please list all company owners and their percentage of ownership below:

Primary Owner's DOB

CPA/Tax Preparer's Name

CPA/Tax Preparer's Email Address

Tax-filing Basis

Primary Bank Website Address

http://

We will need a login to your bank. Some banks send this info to the account owner to send to us. If you receive that account information, please list it below:

Secondary Bank/credit card Website Address

If you use only one bank, please skip this question.

http://

We will need a login to your second bank/credit account. Some banks send this info to the account owner to send to us. If you receive that account information, please list it below:

Tertiary Bank/credit card Website Address

If you use only one bank, please skip this question.

http://

We will need a login to your third bank/credit account. Some banks send this info to the account owner to send to us. If you receive that account information, please list it below:

Are all of your banks/credit cards listed above?

Primary Sales Location Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

State Sales Tax Account/File Number

State Sales Tax Letter ID

This is usually on a recent letter from the state tax agency in reference to the sales tax account and is listed at the top right-hand corner. It allows us to verify the account when we request accountant's access. Alternatively, you can upload a recent letter for the account below.

If your business sells products in multiple jurisdictions, please list them below (to the best of your ability).

LBTD Tax Account/File Number (if applicable; you'll know if it is)

LBTD Tax Account Letter ID (if applicable)

Solid Waste Tax Account/File Number (if applicable; you'll know if it is)

Solid Waste Tax Account Letter ID (if applicable)

Anything else you want us to note on your account?

(Feel free to add concerns, additional logins, etc.)