Common use of Entity Information Clause in Contracts

Entity Information. Entity Name: Entity EIN/TIN: Entity has never completed a Doing Business Data Form. Fill out the entire form. Change from previous Data Form dated . Fill out only those sections that have changed, and indicate the name of the persons who no longer hold positions with the entity. No Change from previous Data Form dated . Skip to the bottom of the last page. Entity is a Non-Profit: Yes No Entity Type: Corporation (any type) Sole Proprietor Joint Venture Other (specify): LLC Partnership (any type) Address: City: State: Zip: Phone : Fax : E-mail: Provide your e-mail address and/or fax number in order to receive notices regarding this form by e-mail or fax. Please fill in the required identification information for each officer listed below. If the entity has no such officer or its equivalent, please check "This position does not exist." If the entity is filing a Change Form and the person listed is replacing someone who was previously disclosed, please check "This person replaced..." and fill in the name of the person being replaced so his/her name can be removed from the Doing Business Database, and indicate the date that the change became effective. This position does not exist The highest ranking officer or manager, such as the President, Executive Director, Sole Proprietor or Chairperson of the Board. First Name: MI: Last: Office Title: Employer (if not employed by entity): Birth Date (mm/dd/yy): Home Phone #: Home Address: This person replaced former CEO: on date: This position does not exist The highest ranking financial officer, such as the Treasurer, Comptroller, Financial Director or VP for Finance. First Name: MI: Last: Office Title: Employer (if not employed by entity): Birth Date (mm/dd/yy): Home Phone #: Home Address: This person replaced former CFO: on date: This position does not exist The highest ranking operational officer, such as the Chief Planning Officer, Director of Operations or VP for Operations. First Name: MI: Last: Office Title: Employer (if not employed by entity): Birth Date (mm/dd/yy): Home Phone #: Home Address: This person replaced former COO: on date: Please fill in the required identification information for all individuals who, through stock shares, partnership agreements or other means, own or control 10% or more of the entity. If no individual owners exist, please check the appropriate box to indicate why and skip to the next page. If the entity is owned by other companies, those companies do not need to be listed. If an owner was identified on the previous page, fill in his/her name and write "See above." If the entity is filing a Change Form, list any individuals who are no longer owners at the bottom of this page. If more space is needed, attach additional pages labeled "Additional Owners." ner The entity is not-for-profit There are no individual ow s No individual owner holds 10% or more shares in the entity Other (explain): First Name: MI: Last: Office Title: Employer (if not employed by entity): Birth Date (mm/dd/yy): Home Phone #: Home Address: First Name: MI: Last: Office Title: Employer (if not employed by entity): Birth Date (mm/dd/yy): Home Phone #: Home Address: First Name: MI: Last: Office Title: Employer (if not employed by entity): Birth Date (mm/dd/yy): Home Phone #: Home Address: Name: Removal Date: Name: Removal Date: Name: Removal Date: