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: