US Business Bank Account Information Request Form – MyUSALLC

Business Bank Account Information Request Form

Company Details
Company Name*
State where company organized in*
Type of Company*
Company Formation Document Type*
Company Formation Document*
Accepted file types: jpg, png, pdf.
Industry*
EIN*
EIN Document (147C OR CP575 LETTER)*
Accepted file types: jpg, png, pdf.
Describe Your Business in 350 Chracters*
Please describe your in detail. Do not type just, e-commerce, sales, or sth. You should detail what you are selling or providing a service. You should mention about your targeting customers. Please type at least 5 or 6 sentences about your business.
US Business Address*
Street Address Apt No. / Suite No City State ZIP Code
Business Website

IMPORTANT: A live and good business website with a US business address helps your bank accounts to be approved.
US Business Phone Number*
This phone number can be a US Mobile Phone Number and be same as one your shareholder phone number
Untitled
- My Company is involved in Cryptocurrency
Beneficial Owners
Co-Founder or Beneficial Owners (>25% Ownership)
Number of total shareholders whose share is more than 25 %*
1st Shareholder Information
First Name*
Middle Name
Last Name*
Email*
Enter Email Confirm Email
US Phone Number
Job Title*
(%) Ownership*
Citizenship Status*
Identification*
Passport Scan*
Accepted file types: jpg, png, pdf.
US Residency Card*
Accepted file types: jpg, png, pdf.
US Driving License*
Accepted file types: jpg, png, pdf.
Home Address*
The address can be outside the US if you are a non-resident. Please enter the correct address where you live most of your time.

Street Address Apt No / Suite No City State / Province / Region ZIP / Postal Code Country
2nd Shareholder Information
First Name*
Middle Name*
Last Name*
Email*
Enter Email Confirm Email
US Phone Number
Job Title*
% Ownership*
Citizenship Status*
Identification*
Passport Scan*
Accepted file types: jpg, png, pdf.
US Residency Card*
Accepted file types: jpg, png, pdf.
US Driving License*
Accepted file types: jpg, png, pdf.
Home Address*
The address can be outside the US if you are a non-resident. Please enter the correct address where you live most of your time.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
3rd Shareholder Information
First Name*
Middle Name*
Last Name*
Email*
Enter Email Confirm Email
US Phone Number
Job Title*
% Ownership*
Citizenship Status*
Identification*
Passport Scan*
Accepted file types: jpg, png, pdf.
US Residency Card*
Accepted file types: jpg, png, pdf.
US Driving License*
Accepted file types: jpg, png, pdf.
Home Address*
The address can be outside the US if you are a non-resident. Please enter the correct address where you live most of your time.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
4th Shareholder Information
First Name*
Middle Name*
Last Name*
Email*
Enter Email Confirm Email
US Phone Number
Job Title*
% Ownership*
Citizenship Status*
Identification*
Passport Scan*
Accepted file types: jpg, png, pdf.
US Residency Card*
Accepted file types: jpg, png, pdf.
US Driving License*
Accepted file types: jpg, png, pdf.
Home Address*
The address can be outside the US if you are a non-resident. Please enter the correct address where you live most of your time.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
5th Shareholder Information
First Name*
Middle Name*
Last Name*
Email*
Enter Email Confirm Email
US Phone Number
Job Title*
% Ownership*
Citizenship Status*
Identification*
Passport Scan*
Accepted file types: jpg, png, pdf.
US Residency Card*
Accepted file types: jpg, png, pdf.
US Driving License*
Accepted file types: jpg, png, pdf.
Home Address*
The address can be outside the US if you are a non-resident. Please enter the correct address where you live most of your time.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Shipping Details
Untitled*
- Shipping Address is different from US Business Address
This address may be an address outside the US.
Shipping Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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