*Proposed Name:

Please select three (3) alternate names:

(1)

(2)

(3)

Physical Address of LLC (No P.O. Boxes):

Mailing Address of LLC:

Members (Include names and addresses):

(1)

(2)

(3)

(4)

Managers (if Manager Managed):

(1)

(2)

(3)

(4)

Members

Member 1

Name:

Home Address:

Social Security No.:

Driver's License No.:

Telephone No.:

Member Certif.:

Member 2

Name:

Home Address:

Social Security No.:

Driver's License No.:

Telephone No.:

Member Certif.:

Member 3

Name:

Home Address:

Social Security No.:

Driver's License No.:

Telephone No.:

Member Certif.:

Member 4

Name:

Home Address:

Social Security No.:

Driver's License No.:

Telephone No.:

Member Certif.:

Type of Business:

Sharing Ratio:

*Please be advised that this form contains the basic information necessary to draft the Articles of Organization and the Operating Agreement. Further communication concerning the details of the operation, sharing ratios, and other terms will likely be required to complete the documents

*Fee - $1,150.00 (inclusive of filing fee costs and corporate book).