Form Rc-L-200b - License Application (Limited Liability Company) Page 6
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10M
/ M
EMBER
ANAGER
The Registrar requires all of the information below for each member (if the applicant is a member-managed LLC) or each
manager (if the applicant is a manager-managed LLC)
1. Name as it appears on your government-Issued ID
2. Title/Position (“Member” or “Manager”)
3. Ownership %
4. Date of Birth (MM/DD/YYYY)
5. Identification No. (Driver’s License or Government ID No.)
6. Social Security Number
7. Business or Residential Address
City
State
Zip Code
8. Mailing Address (If different than business or residential address)
City
State
Zip Code
9. Phone Number
10. Email Address
C
Email / Telephone
ONSENT
11. I consent to receive email notifications from the Registrar at the following email
address
...........................................................................................................................................................................................................
12. I consent to receive text notifications from the Registrar at the following number
.................
“Notifications” include renewal notices and monthly newsletters. By consenting to receive notifications via text or email, you
will not be excluded from receiving notifications by regular mail. You consent by entering the information above.
M
/ M
EMBER
ANAGER
The Registrar requires all of the information below for each member (if the applicant is a member-managed LLC) or each
manager (if the applicant is a manager-managed LLC).
1. Name as it appears on your government-Issued ID
2. Title/Position (“Member” or “Manager”)
3. Ownership %
4. Date of Birth (MM/DD/YYYY)
5. Identification No. (Driver’s License or Government ID No.)
6. Social Security Number
7. Business or Residential Address
City
State
Zip Code
8. Mailing Address (If different than business or residential address)
City
State
Zip Code
9. Phone Number
10. Email Address
C
Email / Telephone
ONSENT
11. I consent to receive email notifications from the Registrar at the following email
address
...........................................................................................................................................................................................................
12. I consent to receive text notifications from the Registrar at the following number
.................
“Notifications” include renewal notices and monthly newsletters. By consenting to receive notifications via text or email, you
will not be excluded from receiving notifications by regular mail. You consent by entering the information above.
1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ●
License Application (LLC)
Form RC-L-200B
Page 4 of 8
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