Request for Pension Proposal Name of Business: * Primary Contact: * Title: Address: * Phone: * Fax: E-Mail Address: * Tax Status: * C Corp S Corp LLC Sole Proprietor Date Business Began: Date of Incorporation: Tax Year End: State of Issue: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Approximate Contribution Desired: $ (per cent of pay or dollar amount) Any current pension plan(s)in force? Yes No If yes, type:- (401(k), Defined Benefit, etc.) E-Mail Address:   IMPORTANT: Do the owners have ownership interests in any other firms? Yes No (If so, supply details in the Textbox below)

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