Montana Form Ma - Master Application Page 3
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1
2
3
4B
Purpose of Application
(You may check more than one box, see the instructions on page 2.)
Open/Reopen Business
Register Trade Name
Open New Location
Merger
Add License/Registration
Change Ownership
Hire Employees
C
Business Ownership
(Check type of Organization)
Sole Proprietorship
Limited Liability Company
Governmen-
tal
Partnership
Corporation
Nonprofit
Limited Liability Partnership
Sub-Chapter S
Other____
Limited Partnership
Closely held C Corporation
Pension/Trust
Assumed Business Name/DBA/Trade Name, Etc. (see instructions)
E-mail address (optional)
Company or Owner Name (see instructions)
Federal Identification Number (FEIN)
or Social Security Number
Business Location Address (cannot be a post office box)
City
State
ZIP + 4
County
Business Phone
Fax Number
Business Mailing Address (if different from above)
City
State
ZIP + 4
Number of Partners/Officers/Members (if applicable)
Date of Incorporation (if applicable) State of Incorporation (if applicable)
D
Multiple Location Information
(Complete this section if you have more than one location. Attach
additional
sheets if necessary.
Location Name
Location Mailing Address
City
State
ZIP + 4
E-Mail (optional)
Location Physical Address
City/County
State
ZIP + 4
Fax Phone Number
Location Contact Name
Location Phone Number
E
Owners, Partners, Corporate Officers or Members/Managers
(or members if no managers were elected.)
Name (Last, First, Middle)
Social Security Number
Home Address (Street or Route, P.O. Box City, State, Zip)
Home Telephone Number
Title
(
)
Name (Last, First, Middle)
Social Security Number
Home Address (Street or Route, P.O. Box City, State, Zip)
Home Telephone Number
Title
(
)
Name (Last, First, Middle)
Social Security Number
Home Address (Street or Route, P.O. Box City, State, Zip)
Home Telephone Number
Title
(
)
(attach additional sheets if necessary)
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Parent category: Legal