WDFI, EIN & UEI REGISTRATION FORM WOHM DBDP STATE OF Wisconsin Department of Financial Institutions - WDFI, EIN & UEI REGISTRATION FORM Your Name * Your Name First First Last Last Your Address * Your Address Your Address Your Address City City State/Province State/Province Zip/Postal Zip/Postal Email * Phone * SSN * This is needed to register your business Business Name * Business Address Business Address Business Address Business Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Is Your Business Registered With the WDFI (Wisconsin Department of Financial Institutions) * Yes No Current or Desired Business Structure * Select an optionSole proprietorshipPartnershipCorporationS corporationLimited Liability Company (LLC)Non-Profit Business Start Date If already in business, please put your start date. Do You Have an EIN #? * Yes No Employer Identification Number Do You Have a UEI #? * Yes No Unique Entity Identifier Do You Have a DUNS #? * Yes No Dun and Bradstreet Authorization Authorize release * I authorize the release of my personal information for the purpose of running a background check on me. I agree that the information shared above is true to my knowledge. Revoke * I may revoke this authorization in writing at any time unless the information has already been shared based on this agreement. Receive copy * I may receive a copy of this Authorization, and a copy of this Authorization will accompany the released information provided to the aforementioned person or agency. Having read or having had it explained to me, I understand fully the contents and purpose of this Authorization. Signature * Clear Date * Captcha If you are human, leave this field blank. Submit Start Over