0001646721-17-000001.txt : 20170310 0001646721-17-000001.hdr.sgml : 20170310 20170310121026 ACCESSION NUMBER: 0001646721-17-000001 CONFORMED SUBMISSION TYPE: D/A PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: Rule 504(b)(1) (not (i), (ii) or (iii)) FILED AS OF DATE: 20170310 DATE AS OF CHANGE: 20170310 EFFECTIVENESS DATE: 20170310 FILER: COMPANY DATA: COMPANY CONFORMED NAME: form.io LLC CENTRAL INDEX KEY: 0001646721 IRS NUMBER: 473405242 STATE OF INCORPORATION: TX FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D/A SEC ACT: 1933 Act SEC FILE NUMBER: 021-267263 FILM NUMBER: 17680962 BUSINESS ADDRESS: STREET 1: 3411 POTOMAC AVE CITY: DALLAS STATE: TX ZIP: 75205 BUSINESS PHONE: 2142368899 MAIL ADDRESS: STREET 1: 3411 POTOMAC AVE CITY: DALLAS STATE: TX ZIP: 75205 D/A 1 primary_doc.xml X0707 D/A LIVE 0001646721 form.io LLC 3411 POTOMAC AVE DALLAS TX TEXAS 75205 2142368899 TEXAS None None Limited Liability Company true 2015 Gary Wetzel 3411 Potomac Avenue Dallas TX TEXAS 75205 Executive Officer Director Manager, CEO Denise Kay 3411 Potomac Avenue Dallas TX TEXAS 75205 Director Manager Travis Tidwell 3411 Potomac Avenue Dallas TX TEXAS 75205 Director Manager Other Technology Decline to Disclose 04 true 0001646721-16-000004 2016-01-13 true true true true Convertible Note false 5000 500000 405000 95000 true 11 12 0 0 0 false form.io LLC /s/ Gary Wetzel Gary Wetzel Manager 2017-03-10