Client Data Information Sheet
Exact legal company name/person:
*
Address 1:
*
Address 2:
City:
*
State:
*
Zip:
*
Contact person:
*
Title:
*
E-Mail:
*
Phone:
*
Fax:
*
Payroll Provider(s):
*
Type of business:
LLC
Sole Proprietor
Partnership
Regular Corp.
S-Corp.
Prof. Corp.
If an LLC, how is the LLC taxed?
Corporation
Partnership
Business Inception Date:
*
State of Incorporation:
*
Fiscal Year End:
*
Business Code/Type:
Tax ID #/ Soc. Sec.#:
*
Union EE's?
Yes
No
Other Affiliated/Related Business:
Yes
No
Name(s):
Have you ever had another qualified retirement plan?
Yes
No
(If yes, additional information is required)
* Corporate Officers
Title
% of Stock Owned
Director on Board?
Y
N
Attorney:
Broker:
Accountant:
Firm:
Firm:
Firm:
Address 1:
Address 1:
Address 1:
Address 2:
Address 2:
Address 2:
City:
City:
City:
State:
Zip:
State:
Zip:
State:
Zip:
Remarks: