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 Number Direct Line Main 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 Number Direct Line Main 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 Number Direct Line Main Type of Entity*Select One S Corporation C Corporation Partnership Sole Proprietorship Professional Corporation - C Corp Professional Corporation - S Corp LLC/LLP Taxed as a C Corp LLC/LLP Taxed as an S Corp LLC/LLP taxed as a Sole Prop/Partnership PLLC Taxed as a C Corp PLLC Taxed as an S Corp PLLC taxed as a Sole Prop/Partnership Non-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*December November October September August July June May April March February January 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 One 401(k) Plan Profit Sharing Plan Cash Balance Plan Defined Benefit Plan (Traditional) 403(b) Plan SIMPLE IRA SEP 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
