Dissolve Business: Intake Form

Please submit the following information via this online form, which is encrypted with SSL to help ensure the data you enter is secure.

Name*
Prefix First Middle Last Suffix
Email*
Enter Email Confirm Email
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Business Information
Dissolve or Reinstate*
- I would like to dissolve a business I own.
- I would like to reinstate a business I own that has been administratively dissolved.
Business Name*
Please include the full legal business name including punctuation and the entity suffix (LLC, Inc., etc.)
Business EIN
Federal tax ID number.
Authorization of Business Owners*
Have the other business owners authorized this action?
- Yes / I am the sole owner
- No
Business Owners and Officers*
Please list each person's title in the business next to their name.
Date of Dissolution*
Enter the date when the business will dissolve.
Date Format: MM slash DD slash YYYY
Reason for Dissolving*
Business Creditors/Claimants
Names and addresses of all known creditors/claimants of the business.
By providing notice to known creditors of dissolution, a business will be able to bar claims not addressed within 120 days. You need not provide any details other than the creditors' contact information.
Additional Information
Please include any additional information you would like our attorneys to know.
Disclaimer*
Our attorneys may review the information you submit for the purposes described on this website. The use of this form for communication with our firm does not establish an attorney-client relationship. Our review of the information sent to us will not preclude us from representing any other client if confidential information is sent through this form.
- I agree
- I do not agree
Name
This field is for validation purposes and should be left unchanged.

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Business Information