Your Name:
|
(Last
Name)
(First
Name)
(Middle
Name)
|
E-mail Address:
|
|
Company or P.A.:
|
|
Street Address:
|
|
City:
|
|
State:
|
|
Zip:
|
|
Phone Number:
|
-
-
|
Best Time to call:
|
:
:
|
|
Company Information:
|
Business Type:
|
|
| Date Business Began:
|
|
| Ending Date of fiscal year:
|
|
For what tax year do you
want the deduction:
|
|
| Annual Contribution Goal:
OR
Annual Percent of Payroll:
|
|
Employees to be favored:
|
|
Do principals have ownership in any other businesses?
|
|
Do you want a fully insured plan?
|
|
Do profits vary significantly
from year to year?
|
|
Other employee fringe benefits:
|
|