Are you currently a business owner?

Yes
No

If yes, What name is the business registered under?

How many years have you owned your business?

Are you planning to start a new business?

Yes
No

Have you ever owned a business before?

Yes
No

What industry or field of business are you considering?

Do you have, or will you have, partners in the business?

Current Business Information:

Company Name:

Address:

Business Phone:

Business email:

Business website:

What type of business is this?

Is this business registered with the Secretary of State's office?

Yes
No

If so, what is the business EIN:

What is the business filing status?

S Corporation
C Corporation
Partnership
Other

Does the business have employees?

Yes
No

How many employees do you have?

Is the business current on its tax obligations?

Yes
No

Does the business offer benefits to employees?

Yes
No

If yes, what type of benefits are offered?

Is the business current on its benefit obligations?

Yes
No

Is your business a Not-for-Profit?

Yes
No

Does your business qualify for Tax Exempt status?

Yes
No

Please explain your legal situation.