Intake Form – Single Shareholder (Standard)

Shareholder’s Name:

Address:

Phone:

Email:

Last Four Digits of SSN:

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:

Bank:

Accountant:

Insurance Agent:

Referred By:

Expedite Through Esquire Assist: * Additional Charge