Sole Proprietor Information

Please complete all information clearly, as all plan documentation will be prepared based on the information supplied on this form.

Business Name
Street Address
City
 State
 Zip Code
Mailing Address (if different from above)
City
 State
 Zip Code
Phone (with Area Code)
 Cell Phone (with Area Code)
 Fax (with Area Code)
Email Address
Owner/Sole Proprietor
 Employer Identification Number
Plan Trustee
 % Ownership of Business
Nature of Business (i.e. construction, medical practice, attorney)
Business Code (6-digit NAICS number, check with your CPA)
Date of Business Commencement
 Fiscal Year
 Plan Year (if diff. than FYE)
CPA Name
Street Address
City
 State
 Zip Code
Phone
 Fax
Attorney Name
Street Address
City
 State
 Zip Code
Phone
 Fax
Completed By
Date Completed

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