| Name and information of person for IRS to contact: |
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| Name: * |
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| Title: * |
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| Phone Number: * |
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| Fax Number: |
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| Social Security Number: * |
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| Will Corporation operate under the same legal name? * |
Yes
No |
| If no please provide DBA name: |
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| Will Employees be hired within 12 months? * |
Yes
No |
| If yes please provide approximate amount of employees |
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| Will the business be providing services involving health, law, accounting, or Consulting? * |
Yes
No |