The CPA Group, PC - Submit Form

Full Name*

Email*

Phone Number*

Business/Entity Name*

Business Organization Type*

Single-Member LLC

Multi-Member LLC

S Corporation

C Corporation

Nonprofit Corporation

Limited Liability Partnership (LLP)

Other entity type

Business Address*

Business City*

Business State*

Business Zip Code*

How many individuals have 25% or greater ownership in the entity (directly or indirectly)?*

How many individuals have substantial control over the operations of the business?*

Who setup the entity? Provide the name of the professional, company, or service that assisted you.*

Who is you primary professional contact within The CPA Group?*

Steven Harner, CPA

Kurt Krueger, CPA

Gary Shaffer, CPA

Gene Wallace, CPA

Dawnata Hopkins, CPA

Alisha Merritt, CPA

Jade Harner

Other

You are solely responsible for your compliance with the CTA, including its BOI reporting requirements and collecting relevant ownership information. We shall have no liability resulting from your failure to comply with CTA. Information regarding the BOI reporting requirements can be found at www.fincen.gov/boi.

BOI Referral Intake