Client Data Information Sheet
Client Information
Exact legal company name or individual's name: *
Address: *
City: * State: * Zip: *
Contact person: * Title: *
E-Mail: * Phone: * Fax: *
 
 
Payroll Provider: *   In-House
Type of business:
            If an LLC, how is the LLC taxed?
 
 
Tax ID #: * (If a Sole proprietor, Social Security #s are not acceptable. Client must apply for an EIN.)
Business Inception Date: * State of Incorporation: * Fiscal Year End: *
Business Code/Type: Union EE's?
Do you own other businesses, does your spouse or does any other immediate family members:
      (if yes complete a seperate Client Data Sheet for each company)
Participating Employer:
                              (Attach seperate Client Data Information Sheet for each entity)
Other Plans
Do you now or have you in the past had a Qualified plan?
Where are the assets held: Exisiting Plan Year End:
  If you have a qualified plan we must have copies of the following immediately:
  • The Adoption Agreement & Plan Document
  • Most recent Valuation
  • Most recent 5500 form filed
Do you have a or a - if so what was the last year funded:
Ownership
* Corporate Officers Title % of Stock Owned Director on Board?
Advisors
Broker: Accountant:
Firm: Firm:
Address: Address:
   
City: City:
State: Zip: State: Zip:
Phone: Phone:
Email: Email:

Remarks:
* denotes required fields
 
Arlene Williams Phone: 818.593.3535
The Senex Group Fax: 818.593.3550
Woodland Hills Financial Center arlene@senexgroup.com
21021 Ventura Boulevard, Suite 310
Woodland Hills, CA 91364