---
title: "New Client/Prospect Information Form"
date: 2021-06-18
author: "Robbie Petrillo"
---

# New Client/Prospect Information Form

## New Client/Prospect Information Form

"\*" indicates required fields

 

Legal Company Name\*



Ownership Breakdown\*

Enter the name(s) of the owner(s) of the company and their ownership percentage (e.g. Jane Doe 80%; John Smith 20%)



Address\*   Street Address   City   State   ZIP / Postal Code 



Please note: This is the address that will appear in your legal plan documents, as well as any governmental forms, some of which may be publicly-available.

Business Phone\*



Number Type\*What type of number is this?Cell NumberDirect LineMain



Fax



Main Contact Name\*   First    Last 

Main Contact must be authorized signer for the Company

Main Contact's Official Job Title\*



Main Contact Email\* 



Main Contact Phone Number



Number TypeWhat type of number is this?Cell NumberDirect LineMain



Assign an Additional Contact for Day-to-Day (Administrative) Correspondence\*  Yes 

  No 





Daily Contact Name\*   First    Last 

Daily Contact's Official Job Title\*



Daily Contact Email\* 



Daily Contact Phone Number



Number TypeWhat type of number is this?Cell NumberDirect LineMain



Type of Entity\*Select OneS CorporationC CorporationPartnershipSole ProprietorshipProfessional Corporation - C CorpProfessional Corporation - S CorpLLC/LLP Taxed as a C CorpLLC/LLP Taxed as an S CorpLLC/LLP taxed as a Sole Prop/PartnershipPLLC Taxed as a C CorpPLLC Taxed as an S CorpPLLC taxed as a Sole Prop/PartnershipNon-Profit



Employer Tax Identification Number (EIN)\*

DO NOT enter a Social Security Number (SSN) here. If the business does not have an EIN yet, enter 99-9999999.



Employer Fiscal Year-end\*DecemberNovemberOctoberSeptemberAugustJulyJuneMayAprilMarchFebruaryJanuary

Select the final month of the fiscal year (most entities are on a calendar year end, and therefore would select "December")



Business/NAICS Code

More info: https://www.census.gov/naics/



Payroll Provider\*

Examples Include ADP, Paychex, QuickBooks, N/A, etc.



Email for Internal Contact Responsible for Payroll (if different than contacts already provided) 



Invoices shall be emailed to\*  



During the current year, have any of the company’s owners had ownership interests in other entities?\*  Yes 

  No





Please explain the above response\*



During the current year, have any family members of the company’s owners had ownership interests in other entities?\*  Yes 

  No





Please explain the above response\*



Does the company receive or provide management services from/to another entity?\*  Yes 

  No





Please explain the above response\*



Does the company employ any relatives of the owners?\*  Yes 

  No 





Has the company ever sponsored a retirement plan that was terminated?\*  Yes 

  No





i.e. SEP, SIMPLE IRA, 401(k), Profit Sharing, Defined Benefit, etc. 

Please explain the above response\*



Does the company currently sponsor a retirement plan?\*  Yes 

  No





Name of Existing Retirement Plan\*



Type of Existing Retirement Plan\*Select One401(k) PlanProfit Sharing PlanCash Balance PlanDefined Benefit Plan (Traditional)403(b) PlanSIMPLE IRASEP



Plan Number

e.g. 001



Original Effective Date of Existing Retirement Plan     



Financial Institution for Existing Retirement Plan



Name of Individual Completing this Form\*   First    Last 

Title



Statement of Accuracy\*Check this box to acknowledge that the information provided in this form is accurate to the best of your knowledge. Information provided herein will be used to inform plan design decisions, legal plan documents, etc. Inaccurate or missing information may lead to incorrect results.

  The information provided herein is accurate to the best of my knowledge 









 Submit