Change of Entity Application
PERSONAL INFORMATION
First Name
Middle Name
Last Name
Primary Email Address
ORGANIZATION INFORMATION
Firm Name
Previous Firm Name(s)
Other Business Names or Aliases You Employ or Have Employed
Mailing Address
Mailing City
Mailing State/Province
Mailing Zip/Postal Code
Business Phone
Business Website
BUSINESS INFORMATION
Date You Established or Acquired Antiquarian Book Business
Corporation, Partnership, Sole Proprietorship, Other
What percent of your business time is devoted to your antiquarian book selling business?
Sales Tax Number/EIN
Issue Date
Registered Where?
Issued in What Name?
LIST ALL PERSONS WITH A PROPRIETARY INTEREST IN YOUR FIRM
Proprietary Interest #1
Name
Address
Percentage Share
Date Acquired
Proprietary Interest #2
Name
Address
Percentage Share
Date Acquired
Proprietary Interest #3
Name
Address
Percentage Share
Date Acquired
Proprietary Interest #4
Name
Address
Percentage Share
Date Acquired
Premises: Shop, Office, Apartment, Home, Other
By Appointment Only
Yes
No
Hours Open to Public
ELECTRONIC SIGNATURE
Name
Authorize e-signature
Yes
No
Contact Information