Biennial statement filing – MASERVIGESTION CORPORATION

Biennial statement filing Form

Please complete the following information.

First Name

Last Name

Legal Business Name

Email Address

Contact Phone

Please upload Certificate of Formation / Incorporation

Choose File

Have there been any changes to the company (address, phone number, ownership/partners)? – If Applicable

EIN / FEIN

Entity Type

Please upload IRS EIN / FEIN Confirmation Letter (CP 575 o 147C)

Choose File

Business Address

Address Line 1

City

State

Zip Code

State of Formation

USDOT Number

Please upload USDOT Confirmation

Choose File

SSN / ITIN ( 999-99-9999)

Identification Number (Passport or ID all ownership/partners)

Please upload Government ID all ownership/partners

Choose File

Authorized Person Name

Authorized Person Title

Owner

Member

Manager

President

Authorization Consent

I certify that the information provided is accurate and I authorize MASERVIGESTION CORPORATION to prepare and submit filings on my behalf with IRS, state agencies, and other authorities as required.

First Name

Last Name