Form Cr-18 - Ownership Disclosure And Signature Form
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1OWNERSHIP DISCLOSURE
AND SIGNATURE FORM
RCN -
FOR OFFICE USE ONLY
Name of business _______________________________________ FEIN ___ ___
___ ___ ___ ___ ___ ___ ___
Please complete the following information so that your customer profile can be maintained with the most
current information possible. If more space is needed, you may copy this form. If the business fails to report
or pay appropriate state taxes, any individual who is responsible for the tax authorizes the Secretary of Revenue
to research the credit history of the business or that individual.
Printed full proper name of Owner, Partner, or Corporate Officer
Signature of Owner, Partner, or Corporate Officer
SSN/FEIN (Circle One) ____________________________________ Title _____________________________________
Home Address ____________________________________________________________________________________
(Street Address)
(City)
(State)
(Zip Code)
Home Telephone (
)_______________________________
Percentage of Ownership ____________%
Do you have control or authority over how business funds or assets are spent?
Yes
No
Date that you became the owner, partner or corporate officer of this business. Month _________ Day _____ Year ______
Printed full proper name of Owner, Partner, or Corporate Officer
Signature of Owner, Partner, or Corporate Officer
SSN/FEIN (Circle One) _____________________________________ Title ____________________________________
Home Address ____________________________________________________________________________________
(Street Address)
(City)
(State)
(Zip Code)
Home Telephone (
)_______________________________
Percentage of Ownership ____________%
Do you have control or authority over how business funds or assets are spent?
Yes
No
Date that you became the owner, partner or corporate officer of this business. Month _________ Day _____ Year ______
Printed full proper name of Owner, Partner, or Corporate Officer Signature of Owner, Partner, or Corporate Officer
SSN/FEIN (Circle One) _____________________________________ Title ____________________________________
Home Address ____________________________________________________________________________________
(Street Address)
(City)
(State)
(Zip Code)
Home Telephone (
)_______________________________
Percentage of Ownership ____________%
Do you have control or authority over how business funds or assets are spent?
Yes
No
Date that you became the owner, partner or corporate officer of this business. Month _________ Day _____ Year ______
Signature of Owner, Partner, or Corporate Officer
Printed full proper name of Owner, Partner, or Corporate Officer
SSN/FEIN (Circle One) _____________________________________ Title ____________________________________
Home Address ____________________________________________________________________________________
(Street Address)
(City)
(State)
(Zip Code)
Home Telephone (
)_______________________________
Percentage of Ownership ____________%
Do you have control or authority over how business funds or assets are spent?
Yes
No
Date that you became the owner, partner or corporate officer of this business. Month _________ Day _____ Year ______
CR-18 (8/99)
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Parent category: Legal