Intake Form – Single Shareholder (Standard)

    Shareholder’s Name:
    Address:
    Phone:
    Email:
    Last Four Digits of SSN:
    Registered Agent:

    Registered Agent:

    Name of Your Business: Confirm designation: LLC, Limited Liability Company, Ltd., etc.
    Business Address:
    Business Phone:
    Business Email:
    Business Website:
    Effective Date:
    Description of Business: If retail, please indicate whether it is a storefront or online
    Is this a Professional Corporation? A corporation formed by a licensed individual (such as a doctor, dentist, engineer, architect, accountant, etc.)
    Employees:

    Number of Employees:

    Date for Wages:

    Bank:
    Accountant:
    Insurance Agent:
    Referred By:
    Expedite Through Esquire Assist: * Additional Charge

    Expedited Service:

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