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 Δ