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Intake Form – Single Shareholder (Standard)

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  3. 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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