Oregon Board of Accountancy
INITIAL FIRM REGISTRATION
FEE $265
3218 Pringle Rd SE #110, Salem, OR
Phone: 503-378-2264 ~ Fax: 503-378-3575 ~ E-Mail: angel.m.legler@oregon.gov ~ Website:
1
GENERAL INFORMATION
If a PO Box, mail drop or pick-up service is used, you must also provide the physical address of the firm.
Firm Name:
Mailing Address:
Physical Address:
Managing Partner:
Phone:
E-Mail:
EIN#
REQUIRED
Firm Phone:
Firm Fax:
Firm E-Mail:
Website:
(REQUIRED)
2
PRINCIPAL PLACE OF BUSINESS / BRANCH OFFICES
YES
NO
A) Is the firm’s principal place of business in Oregon?
B) Is your firm registered with the Secretary of State’s Corporation Division?
C) Is your firm registered in any other State/Jurisdiction? If yes, please provide a list of states.
D) Branch Office(s) in Oregon
List the physical address of each branch office in Oregon, the hours of the
main branch and each branch office that is open to the public and the name and license number of licensee on
duty during business hours. Attach a separate sheet of paper to this form if necessary.
Address
City
Hours
License
3
TYPE OF BUSINESS ORGANIZATION
Sole Proprietor
Assumed Business Name
Partnership
Limited Liability Company
Limited Liability Partnership
Professional Corporation
Business Corporation
Clerk: ______ Date Processed: _____________ SEQ #:
Batch#:____________ Last 4:
2015 INITIAL FIRM REGISTRATION PG 1
Questions? Please contact: (503) 378-2264 / angel.m.legler@oregon.gov or kimberly.fast@oregon.gov / 503-378-2268