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Sole Proprietor Form

    Business Name

    Street Address

    City

    State

    Zip Code

    Mailing Address (if different from above)

    City

    State

    Zip Code

    Phone (with Area Code)

    Cell Phone (with Area Code)

    Fax (with Area Code)

    Email Address

    Owner/Sole Proprietor

    Employer Identification Number

    Plan Trustee

    % Ownership of Business

    Nature of Business (i.e. construction, medical practice, attorney)

    Business Code (6-digit NAICS number, check with your CPA)

    Date of Business Commencement

    Fiscal Year

    Plan Year (if diff. than FYE)

    CPA Name

    Street Address

    City

    State

    Zip Code

    Phone

    Fax

    Attorney Name

    Street Address

    City

    State

    Zip Code

    Phone

    Fax

    Completed By

    Date Completed