Application for Nonprofit Organizations

1) In what state will you be forming your new organization?

State

2) Company Name

a) The name of your organization will be:*

b) If your first choice is unavailable, an alternative name will be:

3) Contact Information

This is the sole authorized contact that we will communicate with throughout the application process.

Contact*

Title

Phone*

Fax

Email*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

5) Resident Agent

This is a person who will accept legal service of process; must be a real person residing in your state of registration; cannot be a P.O. Box

Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

6) Directors

The IRS generally requires a minimum of at least three (3) directors. If you need additional space to list more Directors, please list them on a separate attachment.

Name 1

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Compensation

Name 2

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Compensation

Name 3

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Compensation

President

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Compensation

Secretary

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Compensation

Treasurer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Compensation

Vice President (if applicable)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Compensation

Other Officer (if applicable)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Compensation

Other Officer 2(if applicable)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Compensation

8) Organization Information

All sensitive data filled out on this form will be encrypted.

Date of Incorporation (if applicable)

EIN Number

Will this nonprofit organization have members?

Yes
No

If yes, what benefits do/will the members receive?

Have you ever filed for tax-exempt status before?

Yes
No

If yes, please explain

Has the organization filed any tax returns as a nonprofit?

Yes
No

If yes, please explain

Describe the organization's fundraising program. Are there any available materials on the fundraising program? If yes, please describe:

How does the organization market and advertise itself? (i.e. mailer, magazines)

What assets does the organization have that are directly used for the purposes/ functions of providing the services of the organization. If none, indicate by N/A.

Has the organization entered into any 3rd party contracts?

Yes
No

If yes, please explain and provide copies

If the Board Members are related by family or business, how so?

9) Activities & Programs

Please provide us with the details of the Activities & Programs which will be implemented (in order of importance) by your Organization.

Title of Program 1

Briefly describe the program

When will the program be implemented?

What are the names of the people administering the program?

Where will the program be implemented?

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How much time will your organization spend on the program? (e.g. 10%, 20%)

Title of Program 2

Briefly describe the program

When will the program be implemented?

What are the names of the people administering the program?

Where will the program be implemented?

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How much time will your organization spend on the program? (e.g. 10%, 20%)

Title of Program 3

Briefly describe the program

When will the program be implemented?

What are the names of the people administering the program?

Where will the program be implemented?

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How much time will your organization spend on the program? (e.g. 10%, 20%)

10) Financial Information

Please provide the following information regarding your organization's finances.
IRS Filing Fee (You pay this fee directly to the IRS; Not Seton & Associates) *NOTE: If monies received by your nonprofit from any source equal more than $10,000 in any one year, the IRS filing fee is $850.00. Less than $10,000 = $400.00 IRS Filing Fee

Month the annual accounting period ends

How does the organization finance itself?

Donations from yourself

Yes
No

Donations from private individuals except yourself

Yes
No

Private Grants

Yes
No

Public Grants (i.e. grants from state agencies)

Yes
No

Business income from selling goods and/or services

Yes
No

Other, please explain:

Will you be hiring grant writers who are independent contractors?

Yes
No

Will you be soliciting directly to residents in other states?

Yes
No

What is the amount of income projected from donations from private or public sources? (Estimate numbers to the best of your ability.)

1st Year

2nd Year

3rd Year

If you have income from the sales of merchandise, services or other tangible goods, what amounts will this income be? (Please list the sources of income)

Source of Income	1st Year	2nd Year	3rd Year

How much overhead will your organization have? (i.e. Rent, utilities, wages, office supplies, etc.) Please identify amounts for each category

Source of Income	1st Year	2nd Year	3rd Year

How much overhead will your organization have? (i.e. Rent, utilities, wages, office supplies, etc.) Please identify amounts for each category

1st Year

2nd Year

3rd Year

If known, please list any other income you expect to receive.

Source of Income	1st Year	2nd Year	3rd Year

Please identify salary or wages to be paid to employees or officers. (Estimate numbers to your best ability.)

1st Year

2nd Year

3rd Year

If you are a membership organization, what dues will you receive from members of your organization? (Estimate numbers to your best ability.)

1st Year

2nd Year

3rd Year

11) Employer Identification Number

As part of our formation package, a Form SS-4 will be filed for your new entity. The Form SS-4 is what gives your organization an Employer Identification Number (EIN). To assist us in filing the Form SS-4, please provide the information requested below. All sensitive data filled out on this form will be encrypted.

Principal Officer

Social Security Number

Date Organization Started

Closing Month of Accounting Year

First Date Wages Will Be Paid

Highest # of employees expected in the next 12 mos.

Is the Principal Business Activity manufacturing a good?

To whom are most of your products/services sold?*

Principal Activity

What will you be selling? (Services, goods, or N/A)

Have you ever applied for EIN before?

Yes
No

If yes, when?

In what State and City?

EIN Number

12) Billing & Mailing Information

Billing Information

Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Fax

Email

Mailing Information

To use Billing Information above

Check here

Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Fax

Email

13) Payment Information

All sensitive data filled out on this form will be encrypted.

Card Type

Visa
Mastercard

Name of Cardholder

Credit Card Number

Expiration

3 Digit V-Code

14) ByLaw Information

Please complete this section if your organization does not have ByLaws

Members

Will membership interests be transferable?

Yes
No

Will your organization establish rules and regulations for your membership?

Yes
No

(If so, please understand California law requires that rules and regulations must be reasonable.)

Will members be allowed to vote for the Board?

Yes
No

If yes, what are the requirements?

What other matters will Members be allowed to vote on?

Election of Board Members

How often will you have Board elections?

How long will each Board Member serve?

Will the terms of their service be staggering?

Yes
No

A majority of the number of directors authorized in the articles or bylaws constitutes a quorum of the board for the transaction of business. The articles or bylaws may not provide that a quorum shall be less than 1/5 the number of directors authorized in the articles or bylaws, or less than 2, whichever is larger. Would you like this standard to be any greater?

Yes
No

If yes, what are the requirements?

Committees

Will your Board establish committees?

Yes
No

If the above is yes, please list each committee, the number of members in each committee, their powers and functions, and any requirements.

Name of Committee	# of Members	Powers, Functions, Duties	Requirements:

Will you have a nominating committee?

Yes
No

If yes, describe the nominating process