Florida Professional Entity Intake Form

Professional Corporation
Professional LLC

Professional Corporation

Florida Professional Corporation Intake Form

"*" indicates required fields

To use the quick set up, your corporation must:
– be based in Florida;
– Not have a shareholder that is a corporation, LLC, or trust;
-Must be engaged in certain professions that are licensed by the state such as medicine, dentistry, chiropractic; nursing; marriage and family therapy; physical therapy, social work; law, and accounting;
– Have five or fewer shareholders.

For all other companies, click here

Contact Information

This is the contact information which will be used to register your business. Please double check to ensure accuracy before submitting your information.

Name*

First Last

Phone*

Email*

What is the profession that you are forming this professional corporation under?*

medicine, dentistry, chiropractic; nursing; marriage and family therapy; physical therapy, social work; law, and accounting; etc.

What is your state license number for your profession?*

Please enter the state license number given to you by the state accreditation board of this profession.

Entity Name (first choice)*

Your company name must be unique in your formation state. We’ll check name availability and use the first name available in the order you provide. We’ll add “Inc.” to the ending unless you provide an alternative.

Entity Name (second choice)*

Physical Address*

Street Address Address Line 2 City State ZIP Code

Mailing Address*

Same as Physical Address

Street Address Address Line 2 City State ZIP Code

Registered Agent

Every corporation is legally required to have a Registered Agent to accept service of process (e.g. civil complaints in a legal proceeding ) on behalf of the corporation. Registered Agent services are included for the first year as part of our standard package. If you would like to designate a different Registered Agent, please check “no” below and provide the name of an individual and a physical address within the State of Delaware at which the designated person is generally present during normal business hours.

Registered Agent Services for the first year are included in the package. Would you like to accept them?*

Yes

Name of Registered Agent*

Physical Address of Registered Agent*

Street Address Address Line 2 City State ZIP Code

Shareholder Information

Owners of the corporation are called shareholders. Every corporation must authorize the number of shares available to be issued to shareholders in its Articles of Incorporation. Once all of the authorized shares have been issued, the corporation cannot issue additional new shares until the Articles of Incorporation are amended to authorize more shares.

Unless otherwise specified, we recommend authorizing 10,000 shares of stock and then issuing only 1,000 shares to the initial shareholders, leaving 9,000 shares available for future investors and shareholders. Each shareholder’s percentage ownership interest is determined by dividing the number of shares issued to the shareholder by the total number of shares issued to all shareholders. For example, if there are two initial shareholders who each want to own 50% of the corporation, each shareholder would be issued 500 shares.

A corporation must pay corporate taxes on its profits at the state and federal levels unless it makes an S-Corp election, which allows the profits and losses to pass through to the individual shareholders. This avoids double taxation on profits at the corporate level and on dividends at the individual shareholder level. You cannot make the S-Corp election if there will be more than 100 shareholders or if any of the shareholders is a corporation or LLC.

What is the total number of shareholders?*

Enter a number between 1 and 5.

How many total shares are authorized?*

The default is to authorize 10,000 shares unless you specify another amount.

Par value of shares*

Please enter a number from .01 to 5000000.

We default to $.01 par value to minimize filing fees.

How many total shares are issued?*

The default is to issue 10% of the authorized shares (1,000), or an amount divisible by the total number of shareholders so as to avoid fractional shares. For example, 999 shares for 3 shareholders, or 1000 shares for 5 shareholders.

List of Shareholders

Shareholder Name	Percentage Ownership	Number of Shares	Initial Capital Contribution	Actions

There are no Shareholders.

Maximum number of shareholders reached.

NOTE: Limit “Add Shareholder” to only number specified and not more than 100% interest total.

Will you be making the S-corp election?*

Yes

As an S-Corp, your company’s fiscal year end is Dec. 31st.

If your company's fiscal year end is other than Dec. 31, enter it here*

This is the date your company will close its books for tax and accounting purposes. We’ll review all your answers for consistency and either make the necessary adjustment or contact you to resolve the inconsistency.

Company Directors

Corporations are managed by the directors. The minimum number of directors is three (3) unless there are fewer than three (3) shareholders, in which case the number of directors may be equal to the number of shareholders (e.g. if there is only one (1) shareholder, only one (1) director is legally required.)

Unless otherwise specified, all shareholders will be listed as directors with the corporation’s address as the contact address for each director.

Company Directors

Director Name	Actions

There are no Directors.

Maximum number of directors reached.

NOTE: require Director info fields according to number of shareholders: 1 shareholder needs exactly 1 director; 2 shareholders needs exactly two directors; 3 or more shareholders requires exactly 3 directors

NOTE: Pre-populate the Directors fields with Shareholder info and offer the edit and delete options.

Company Officers

Officers are appointed by the Board of Directors and each corporation is required to have the following three corporate officers: CEO/President, CFO/Treasurer, and Secretary. One person may serve as one, two or all three officers at the same time.

Company Officers

Will One Officer Have All Three Titles?	Officer Name	CEO/President Officer Name	CFO/Treasurer Officer Name	Secretary Officer Name	Actions

There are no Officers.

Maximum number of officers reached.

NOTE: For the Company Officers, pre-populate the fields with the previous entries for shareholders and directors and allow the same person to hold multiple titles. For example, in single shareholder companies, that shareholder should be listed for all of the titles with edit or delete options.

EIN Responsible Party

All corporations are required to have a Federal Employee Identification Number (“FEIN” or just “EIN”). In order to obtain an EIN, the IRS requires the corporation to designate one executive of the corporation (generally the CEO) to be the responsible party for the corporation. The IRS requires the social security number of the responsible party to be included in the application for the EIN.

EIN Responsible Party Name

First Last

Title*

SSN*

NOTE: for testing purposes only. Please do not enter a REAL social security number in this field until security evaluation is complete.

Phone*

Email*

Mailing Address*

Same as Corporate Address

Street Address Address Line 2 City State ZIP Code

Florida Professional LLC Intake Form

Step 1 of 2

50%

Is your business in Florida?(Required)

Yes

Contact Form

Please fill out this contact form and a representative will contact you.

Full Name(Required)

Email(Required)

Phone Number(Required)

Contact Form

Please fill out your contact information to proceed.

Full Name(Required)

Email(Required)

Phone

What is the profession that you are forming this Professional Corporation under?*(Required)

Medicine, dentistry, chiropractic; nursing; marriage and family therapy; physical therapy, social work; law, and accounting; etc.

What is your state license number for your profession?*(Required)

Please enter the state license number given to you by the state accreditation board of this profession.

Entity Name – First Choice(Required)

Your LLC name must be unique in your formation state. We’ll check name availability and use the first name available in the order you provide. We will automatically insert the required “LLC” suffix to the company name.

Entity Name – Second Choice

LLC Physical Address(Required)

Street Address Address Line 2 City State ZIP Code

Your LLC must have a physical street address, which may be a residence address but not a PO Box. You may list a different mailing address including a PO Box or PMB where such addresses are permitted on forms.

Is the mailing address the same as the physical address for the LLC?(Required)

Yes

Mailing Address Of The LLC(Required)

Street Address Address Line 2 City State ZIP Code

Registered Agent Services for the first year are included in the package. If you wish to select your own Registered Agent, please check the box

Yes, I would like my own registered agent.

Please provide the name and address of the registered agent.

Name of registered agent

Address of registered agent

Street Address Address Line 2 City State ZIP Code

How many members are in your company?(Required)

At least 1 member. If you have 10+ please call 1 (800) 503-4443 to speak to a specialist.

Unfortunately, this form does not support LLC’s with 10 or more members. Please contact us by calling (800) 503-4443 or emailing admin@nwincorp.com for personalized help.

Member #1 Information

Member #1: Full Name of Individual Member or Legal Entity Name(Required)

Member #1: Would you like to use the same mailing address of this LLC being formed or choose a different mailing address for this specific member/entity?(Required)

Use the same mailing address of this LLC

Use a different mailing address

Member #1: Mailing Address

Street Address Address Line 2 City State ZIP Code

Member #1: Email(Required)

Member #1: SSN or EIN (Tax-ID)(Required)

123-45-6789 (SSN) or 12-3456789 (EIN)

Member #1: Percentage (%) Ownership of the LLC being formed(Required)

Please enter a number from 1 to 100.

If owning 50%, please put 50. If LLC only has a single member, the answer should be 100.

Member #1: What is the initial capital contribution from this member?

Please enter the amount this member will contribute to the company. If you don’t know, please leave it blank and we’ll enter a nominal default amount.

Member #2 Information

Member #2: Full Name of Individual Member or Legal Entity Name(Required)

Member #2: Would you like to use the same mailing address of this LLC being formed or choose a different mailing address for this specific member/entity?(Required)

Use the same mailing address of this LLC

Use a different mailing address

Member #2: Mailing Address

Street Address Address Line 2 City State ZIP Code

Member #2: Email(Required)

Member #2: SSN or EIN (Tax-ID)(Required)

123-45-6789 (SSN) or 12-3456789 (EIN)

Member #2: Percentage (%) Ownership of the LLC being formed(Required)

Please enter a number from 1 to 100.

If owning 50%, please put 50. If LLC only has a single member, the answer should be 100.

Member #2: What is the initial capital contribution from this member?

Please enter the amount this member will contribute to the company. If you don’t know, please leave it blank and we’ll enter a nominal default amount.

Member #3 Information

Member #3: Full Name of Individual Member or Legal Entity Name(Required)

Member #3: Would you like to use the same mailing address of this LLC being formed or choose a different mailing address for this specific member/entity?(Required)

Use the same mailing address of this LLC

Use a different mailing address

Member #3: Mailing Address

Street Address Address Line 2 City State ZIP Code

Member #3: Email(Required)

Member #3: SSN or EIN (Tax-ID)(Required)

123-45-6789 (SSN) or 12-3456789 (EIN)

Member #3: Percentage (%) Ownership of the LLC being formed(Required)

Please enter a number from 1 to 100.

If owning 50%, please put 50. If LLC only has a single member, the answer should be 100.

Member #3: What is the initial capital contribution from this member?

Please enter the amount this member will contribute to the company. If you don’t know, please leave it blank and we’ll enter a nominal default amount.

Member #4 Information

Member #4: Full Name of Individual Member or Legal Entity Name(Required)

Member #4: Would you like to use the same mailing address of this LLC being formed or choose a different mailing address for this specific member/entity?(Required)

Use the same mailing address of this LLC

Use a different mailing address

Member #4: Mailing Address

Street Address Address Line 2 City State ZIP Code

Member #4: Email(Required)

Member #4: SSN or EIN (Tax-ID)(Required)

123-45-6789 (SSN) or 12-3456789 (EIN)

Member #4: Percentage (%) Ownership of the LLC being formed(Required)

Please enter a number from 1 to 100.

If owning 50%, please put 50. If LLC only has a single member, the answer should be 100.

Member #4: What is the initial capital contribution from this member?

Please enter the amount this member will contribute to the company. If you don’t know, please leave it blank and we’ll enter a nominal default amount.

Member #5 Information

Member #5: Full Name of Individual Member or Legal Entity Name(Required)

Member #5: Would you like to use the same mailing address of this LLC being formed or choose a different mailing address for this specific member/entity?(Required)

Use the same mailing address of this LLC

Use a different mailing address

Member #5: Mailing Address

Street Address Address Line 2 City State ZIP Code

Member #5: Email(Required)

Member #5: SSN or EIN (Tax-ID)(Required)

123-45-6789 (SSN) or 12-3456789 (EIN)

Member #5: Percentage (%) Ownership of the LLC being formed(Required)

Please enter a number from 1 to 100.

If owning 50%, please put 50. If LLC only has a single member, the answer should be 100.

Member #5: What is the initial capital contribution from this member?

Please enter the amount this member will contribute to the company. If you don’t know, please leave it blank and we’ll enter a nominal default amount.

Member #6 Information

Member #6: Full Name of Individual Member or Legal Entity Name(Required)

Member #6: Would you like to use the same mailing address of this LLC being formed or choose a different mailing address for this specific member/entity?(Required)

Use the same mailing address of this LLC

Use a different mailing address

Member #6: Mailing Address

Street Address Address Line 2 City State ZIP Code

Member #6: Email(Required)

Member #6: SSN or EIN (Tax-ID)(Required)

123-45-6789 (SSN) or 12-3456789 (EIN)

Member #6: Percentage (%) Ownership of the LLC being formed(Required)

Please enter a number from 1 to 100.

If owning 50%, please put 50. If LLC only has a single member, the answer should be 100.

Member #6: What is the initial capital contribution from this member?

Please enter the amount this member will contribute to the company. If you don’t know, please leave it blank and we’ll enter a nominal default amount.

Member #7 Information

Member #7: Full Name of Individual Member or Legal Entity Name(Required)

Member #7: Would you like to use the same mailing address of this LLC being formed or choose a different mailing address for this specific member/entity?(Required)

Use the same mailing address of this LLC

Use a different mailing address

Member #7: Mailing Address

Street Address Address Line 2 City State ZIP Code

Member #7: Email(Required)

Member #7: SSN or EIN (Tax-ID)(Required)

123-45-6789 (SSN) or 12-3456789 (EIN)

Member #7: Percentage (%) Ownership of the LLC being formed(Required)

Please enter a number from 1 to 100.

If owning 50%, please put 50. If LLC only has a single member, the answer should be 100.

Member #7: What is the initial capital contribution from this member?

Please enter the amount this member will contribute to the company. If you don’t know, please leave it blank and we’ll enter a nominal default amount.

Member #8 Information

Member #8: Full Name of Individual Member or Legal Entity Name(Required)

Member #8: Would you like to use the same mailing address of this LLC being formed or choose a different mailing address for this specific member/entity?(Required)

Use the same mailing address of this LLC

Use a different mailing address

Member #8: Mailing Address

Street Address Address Line 2 City State ZIP Code

Member #8: Email(Required)

Member #8: SSN or EIN (Tax-ID)(Required)

123-45-6789 (SSN) or 12-3456789 (EIN)

Member #8: Percentage (%) Ownership of the LLC being formed(Required)

Please enter a number from 1 to 100.

If owning 50%, please put 50. If LLC only has a single member, the answer should be 100.

Member #8: What is the initial capital contribution from this member?

Please enter the amount this member will contribute to the company. If you don’t know, please leave it blank and we’ll enter a nominal default amount.

Member #9 Information

Member #9: Full Name of Individual Member or Legal Entity Name(Required)

Member #9: Would you like to use the same mailing address of this LLC being formed or choose a different mailing address for this specific member/entity?(Required)

Use the same mailing address of this LLC

Use a different mailing address

Member #9: Mailing Address

Street Address Address Line 2 City State ZIP Code

Member #9: Email(Required)

Member #9: SSN or EIN (Tax-ID)(Required)

123-45-6789 (SSN) or 12-3456789 (EIN)

Member #9: Percentage (%) Ownership of the LLC being formed(Required)

Please enter a number from 1 to 100.

If owning 50%, please put 50. If LLC only has a single member, the answer should be 100.

Member #9: What is the initial capital contribution from this member?

Please enter the amount this member will contribute to the company. If you don’t know, please leave it blank and we’ll enter a nominal default amount.

Will you be making the S-Corp election?

Yes

If you are not sure about this question, please contact us at 1 (800) 503-4443

Will the LLC be managed by all of the members or by managers?(Required)

Member managed: All of the owners participate in running the business.

Manager managed: management is delegated to one person or multiple managers

If you are not sure about this question, please contact us at 1 (800) 503-4443

How many managers are in your company(Required)

10+

This form does not support receiving more than 10 managers. Please contact us at 1 (800) 503-4443 to speak to a specialist regarding this.

Manager #1 Information

Manager #1: Full Name(Required)

Manager #1: Would you like to use the same mailing address of this LLC being formed or choose a different mailing address for this specific manager?(Required)

Yes, use the same mailing address.

No, use a separate mailing address for this manager.

Manager #1: Address(Required)

Street Address Address Line 2 City State ZIP Code

Manager #1: Email Address(Required)

Manager #1: Social Security Number (SSN)(Required)

Example: 123-45-6789

Manager #2 Information

Manager #2: Full Name(Required)

Manager #2: Would you like to use the same mailing address of this LLC being formed or choose a different mailing address for this specific manager?(Required)

Yes, use the same mailing address.

No, use a separate mailing address for this manager.

Manager #2: Address(Required)

Street Address Address Line 2 City State ZIP Code

Manager #2: Email Address(Required)

Manager #2: Social Security Number (SSN)(Required)

Example: 123-45-6789

Manager #3 Information

Manager #3: Full Name(Required)

Manager #3: Would you like to use the same mailing address of this LLC being formed or choose a different mailing address for this specific manager?(Required)

Yes, use the same mailing address.

No, use a separate mailing address for this manager.

Manager #3: Address(Required)

Street Address Address Line 2 City State ZIP Code

Manager #3: Email Address(Required)

Manager #3: Social Security Number (SSN)(Required)

Example: 123-45-6789

Manager #4 Information

Manager #4: Full Name(Required)

Manager #4: Would you like to use the same mailing address of this LLC being formed or choose a different mailing address for this specific manager?(Required)

Yes, use the same mailing address.

No, use a separate mailing address for this manager.

Manager #4: Address(Required)

Street Address Address Line 2 City State ZIP Code

Manager #4: Email Address(Required)

Manager #4: Social Security Number (SSN)(Required)

Example: 123-45-6789

Manager #5 Information

Manager #5: Full Name(Required)

Manager #5: Would you like to use the same mailing address of this LLC being formed or choose a different mailing address for this specific manager?(Required)

Yes, use the same mailing address.

No, use a separate mailing address for this manager.

Manager #5: Address(Required)

Street Address Address Line 2 City State ZIP Code

Manager #5: Email Address(Required)

Manager #5: Social Security Number (SSN)(Required)

Example: 123-45-6789

Manager #6 Information

Manager #6: Full Name(Required)

Manager #6: Would you like to use the same mailing address of this LLC being formed or choose a different mailing address for this specific manager?(Required)

Yes, use the same mailing address.

No, use a separate mailing address for this manager.

Manager #6: Address(Required)

Street Address Address Line 2 City State ZIP Code

Manager #6: Email Address(Required)

Manager #6: Social Security Number (SSN)(Required)

Example: 123-45-6789

Manager #7 Information

Manager #7: Full Name(Required)

Manager #7: Would you like to use the same mailing address of this LLC being formed or choose a different mailing address for this specific manager?(Required)

Yes, use the same mailing address.

No, use a separate mailing address for this manager.

Manager #7: Address(Required)

Street Address Address Line 2 City State ZIP Code

Manager #7: Email Address(Required)

Manager #7: Social Security Number (SSN)(Required)

Example: 123-45-6789

Manager #8 Information

Manager #8: Full Name(Required)

Manager #8: Would you like to use the same mailing address of this LLC being formed or choose a different mailing address for this specific manager?(Required)

Yes, use the same mailing address.

No, use a separate mailing address for this manager.

Manager #8: Address(Required)

Street Address Address Line 2 City State ZIP Code

Manager #8: Email Address(Required)

Manager #8: Social Security Number (SSN)(Required)

Example: 123-45-6789

Manager #9 Information

Manager #9: Full Name(Required)

Manager #9: Would you like to use the same mailing address of this LLC being formed or choose a different mailing address for this specific manager?(Required)

Yes, use the same mailing address.

No, use a separate mailing address for this manager.

Manager #9: Address(Required)

Street Address Address Line 2 City State ZIP Code

Manager #9: Email Address(Required)

Manager #9: Social Security Number (SSN)(Required)

Example: 123-45-6789

Which member/entity will be the EIN responsible party?

Member #1

Which member/entity will be the EIN responsible party?

Member #1

Member #2

Which member/entity will be the EIN responsible party?

Member #1

Member #2

Member #3

Which member/entity will be the EIN responsible party?

Member #1

Member #2

Member #3

Member #4

Which member/entity will be the EIN responsible party?

Member #1

Member #2

Member #3

Member #4

Member #5

Which member/entity will be the EIN responsible party?

Member #1

Member #2

Member #3

Member #4

Member #5

Member #6

Which member/entity will be the EIN responsible party?

Member #1

Member #2

Member #3

Member #4

Member #5

Member #6

Member #7

Which member/entity will be the EIN responsible party?

Member #1

Member #2

Member #3

Member #4

Member #5

Member #6

Member #7

Member #8

Which member/entity will be the EIN responsible party?

Member #1

Member #2

Member #3

Member #4

Member #5

Member #6

Member #7

Member #8

Member #9

What is the title of this member?(Required)

CEO, CFO, CTO, Etc.

What is the contact number of this member?(Required)

By clicking this checkbox, I authorize Nationwide Incorporators to submit the required forms for the EIN in the name of the responsible party(Required)

I authorize Nationwide Incorporators to submit the required forms for the EIN of the responsible party.

General Questions Regarding the LLC

Please describe what this LLC will be engaged in(Required)

Does the company own a vehicle > 55,000 GVW?(Required)

Yes

Gross Vehicle Weight (GVW) — the value specified by the manufacturer as the maximum total loaded weight of a single vehicle.

Does the company engage in casino, gambling, or wagering?(Required)

Yes

Does the company collect federal excise taxes?(Required)

Yes

Does the company sell alcohol, tobacco, or firearms?(Required)

Yes

Number of current employees?(Required)

Number of employees anticipated in the next 12 months?(Required)

First date to pay wages?

MM slash DD slash YYYY

If you do not have any employees, you can skip this question.

Your company's fiscal year end will be Dec. 31(Required)

Yes. (Most Common)

No, we have a different date for fiscal year end.

What is the fiscal year end of this company?(Required)

DD/MM

Your corporate records file will be emailed to you. Would you like a physical binder as well? (additional $150 fee)(Required)

Yes

No Manager or Member of this Limited Liability Company has an outstanding final judgment issued by the Division of Labor Standards Enforcement or a court of law, for which no appeal therefrom is pending, for the violation of any wage order or provision of the Labor Code.(Required)

Yes

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Florida Professional Entity Intake Form

Florida Professional Corporation Intake Form

Contact Information

Registered Agent

Shareholder Information

Company Directors

Company Officers

EIN Responsible Party

Company Information

Florida Professional LLC Intake Form

Contact Form

Contact Form

Please provide the name and address of the registered agent.

Unfortunately, this form does not support LLC’s with 10 or more members. Please contact us by calling (800) 503-4443 or emailing admin@nwincorp.com for personalized help.

Member #1 Information

Member #2 Information

Member #3 Information

Member #4 Information

Member #5 Information

Member #6 Information

Member #7 Information

Member #8 Information

Member #9 Information

This form does not support receiving more than 10 managers. Please contact us at 1 (800) 503-4443 to speak to a specialist regarding this.

Manager #1 Information

Manager #2 Information

Manager #3 Information

Manager #4 Information

Manager #5 Information

Manager #6 Information

Manager #7 Information

Manager #8 Information

Manager #9 Information

General Questions Regarding the LLC

Quicklinks

Contact