Shane Financial - New Client

Please fill out the form below to become a new client

Corporation/Business Information:

Corporation/Business Name: Type: Proprietor Corporation Partnership

Corporation #: Industry Activity: Began operation:

This is a New Business Hired Employee Purchased Business Other: County:

Do you sell any products: Yes No If yes, do you have a permit? Yes No If yes, what is the number?

Corporation #: Type: C Corp S Corp LLC LLP

Do you have DBA: Yes No Do you have Tax ID/TIN: Yes No If yes, what is the #: Tax ID Number

If no, Have you Applied for Tax ID for any Business before? Yes No

If yes, provide us with the old info: Tax ID Business Name Type

Began operation: Do you have employees? Yes No If yes, since when? W-2 1099

How many? Employees: Employees: 1099:

Do you have a EDD #? Yes No If yes, what is the EDD number?

If No, Have you registered with EDD before? Yes No If yes, what is the EDD number?

Address: Suite: City: Zip Code:

Telephone: Cell: Fax:

Personal Information:

First Name: Last Name: (as it appears on your social security card)

SSN: - - Driver's License: DOB:

Address: Suite: City: Zip Code:

Email Address:

What percentage do you own of the above corporation? %

First Name: Last Name: (as it appears on your social security card)

SSN: - - Driver's License: DOB:

Address: Suite: City: Zip Code:

Email Address:

What percentage do you own of the above corporation? %

South Bay:

(877) SHANE4ME
(877) 742-6346
(310) 986-8276
(310) 732-1339

San Fernando Valley:

(877) TZURCPA
(877) 898-7272
(818) 654-5701
Fax: (818) 444-3254

San Deigo:

(858) 699-5474

Israel:

03-97895554