Foreign State Qualifications - Q - Montero Corporate Services

Qualification Questionnaire

Form Completed by*
E-Mail Address*
Bill to:
Bill to Address:
Street Address Address Line 2 City State ZIP Code
Qualification State*
Entity Name*
Entity Type*
LLC Management
Please attach copy of Articles of Incorporation/Organization
FEIN for Entity*
Nature of Business*
Fiscal Year End*
Directors/Members

Directors

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list remove

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Members

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list remove

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Manager(s)

list add

list remove

Click plus sign on the right to add more managers

Officers
President
Secretary
Treasurer (CFO)
Additional Officers
- Yes
- No
Additional Officers

List here

Name	Title

Address of Entity*
Street Address Address Line 2 City State ZIP Code
Phone Number*
Fax
Mailing Address*
- Same
- Different
Mailing Address
Street Address Address Line 2 City State ZIP Code
Issuance of Stock/Membership Interest

Shareholders

Shareholder Name	Number of Shares

Membership Interest

Member Name	Membership Interest Percentage Held

Additional information (if any)