Agent
Information
*All
blue fields must be answered* |
|
| Name |
|
| Address |
|
Phone
Number
(10 digit example 4098888888) |
|
E-mail
Address
(Email example name@mail.com) |
|
| |
|
| Prospect
Information |
|
| Name
of Business |
|
| |
Date
of Incorporation |
| Tax
Status |
Incorporated
|
| |
Date
Business Began |
| |
Unincorporated
|
| |
|
| Tax
Year End |
|
| |
|
Approximate
contribution desired
(percent of pay or dollar amount) |
|
|
Other
comments related to plan design, such as type of
plan desired, which employees to favor, etc.
|
| Any
current pension plan in force? |
Yes
No |
If
So, Please Supply Details Here
|
| Do
the owners have ownership interests in any other
firms? |
Yes
No |
If
So, Please Supply Details Here
|
