This form contains 89 fields organized into 1 section. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
EIN Text
Max length: 10 characters
topmostSubform[0].Page1[0].f1_2[0 Text
2 Trade name of business (if different from name on line 1) Text
3 Executor, administrator, trustee, "care of" name Text
4a Mailing address (room, apt., suite no. and street, or P.O. box) Text
4b City, state, and ZIP code (if foreign, see instructions) Text
5a Street address (if different) (Don't enter a P.O. box.) Text
5b City, state, and ZIP code (if foreign, see instructions) Text
6 County and state where principal business is located Text
7a Name of responsible party Text
7b SSN, ITIN, or EIN Text
Max length: 11 characters
topmostSubform[0].Page1[0].c1_1[0]_1 CheckBox
topmostSubform[0].Page1[0].c1_1[1]_2 CheckBox
8b If 8a is "Yes," enter the number of LLC members Text
topmostSubform[0].Page1[0].c1_2[0]_1 CheckBox
topmostSubform[0].Page1[0].c1_2[1]_2 CheckBox
topmostSubform[0].Page1[0].c1_3[0]_1 CheckBox
Sole proprietor (SSN) Text
Max length: 11 characters
topmostSubform[0].Page1[0].c1_3[1]_8 CheckBox
topmostSubform[0].Page1[0].f1_14[0 Text
Max length: 11 characters
topmostSubform[0].Page1[0].c1_3[2]_2 CheckBox
topmostSubform[0].Page1[0].c1_3[3]_9 CheckBox
topmostSubform[0].Page1[0].f1_15[0 Text
Max length: 11 characters
topmostSubform[0].Page1[0].c1_3[4]_3 CheckBox
topmostSubform[0].Page1[0].f1_16[0 Text
topmostSubform[0].Page1[0].c1_3[5]_10 CheckBox
topmostSubform[0].Page1[0].f1_17[0 Text
Max length: 11 characters
topmostSubform[0].Page1[0].c1_3[6]_4 CheckBox
topmostSubform[0].Page1[0].c1_3[7]_11 CheckBox
topmostSubform[0].Page1[0].c1_3[8]_14 CheckBox
topmostSubform[0].Page1[0].c1_3[9]_5 CheckBox
topmostSubform[0].Page1[0].c1_3[10]_12 CheckBox
topmostSubform[0].Page1[0].c1_3[11]_15 CheckBox
topmostSubform[0].Page1[0].c1_3[12]_6 CheckBox
topmostSubform[0].Page1[0].f1_18[0 Text
topmostSubform[0].Page1[0].c1_3[13]_13 CheckBox
topmostSubform[0].Page1[0].c1_3[14]_16 CheckBox
topmostSubform[0].Page1[0].c1_3[15]_7 CheckBox
topmostSubform[0].Page1[0].f1_19[0 Text
Group Exemption Number (GEN) if any Text
State Text
Foreign country Text
topmostSubform[0].Page1[0].c1_4[0]_5 CheckBox
topmostSubform[0].Page1[0].f1_24[0 Text
topmostSubform[0].Page1[0].c1_4[1]_1 CheckBox
topmostSubform[0].Page1[0].f1_25[0 Text
topmostSubform[0].Page1[0].f1_26[0 Text
topmostSubform[0].Page1[0].c1_4[2]_6 CheckBox
topmostSubform[0].Page1[0].f1_27[0 Text
topmostSubform[0].Page1[0].c1_4[3]_7 CheckBox
topmostSubform[0].Page1[0].c1_4[4]_2 CheckBox
topmostSubform[0].Page1[0].c1_4[5]_8 CheckBox
topmostSubform[0].Page1[0].f1_28[0 Text
topmostSubform[0].Page1[0].c1_4[6]_3 CheckBox
topmostSubform[0].Page1[0].c1_4[7]_9 CheckBox
topmostSubform[0].Page1[0].f1_29[0 Text
topmostSubform[0].Page1[0].c1_4[8]_4 CheckBox
topmostSubform[0].Page1[0].f1_30[0 Text
Date business started or acquired (month, day, year). See instructions. 11 Text
12 Closing month of accounting year Text
topmostSubform[0].Page1[0].f1_33[0 Text
Household Text
Other Text
topmostSubform[0].Page1[0].c1_5[0]_1 CheckBox
topmostSubform[0].Page1[0].f1_36[0 Text
topmostSubform[0].Page1[0].c1_6[0]_7 CheckBox
topmostSubform[0].Page1[0].c1_6[1]_10 CheckBox
topmostSubform[0].Page1[0].c1_6[2]_1 CheckBox
topmostSubform[0].Page1[0].c1_6[3]_3 CheckBox
topmostSubform[0].Page1[0].c1_6[4]_5 CheckBox
topmostSubform[0].Page1[0].c1_6[5]_8 CheckBox
topmostSubform[0].Page1[0].c1_6[6]_11 CheckBox
topmostSubform[0].Page1[0].c1_6[7]_12 CheckBox
topmostSubform[0].Page1[0].c1_6[8]_2 CheckBox
topmostSubform[0].Page1[0].c1_6[9]_4 CheckBox
topmostSubform[0].Page1[0].c1_6[10]_6 CheckBox
topmostSubform[0].Page1[0].c1_6[11]_9 CheckBox
topmostSubform[0].Page1[0].f1_37[0 Text
topmostSubform[0].Page1[0].f1_38[0 Text
topmostSubform[0].Page1[0].c1_7[0]_1 CheckBox
topmostSubform[0].Page1[0].c1_7[1]_2 CheckBox
If "Yes," write previous EIN here Text
Max length: 10 characters
Designee's name Text
Designee's telephone number (include area code) Text
Address and ZIP code Text
Designee's fax number (include area code) Text
Name and title (type or print clearly) Text
Applicant's telephone number (include area code) Text
Applicant's fax number (include area code) Text