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General Company Information:

Business Name:

Your Phone:

Your Email

Business Type:

Business Start Date

Other Information:

What is your ideal contribution amount for this year?

If other, specify ideal contribution amount:

Do the Owners control or own other businesses?
YesNo

Is the Business affiliated with any other businesses?
YesNo

Is the Business a subsidiary of any other business?
YesNo

Is there any retirement plan/account in effect?
YesNo

How many employees do you currently have?

How many employees are part-time?

How many employees earn more than $100,000 per year?