Loren D. Stark Company, Inc.

SPONSOR INFORMATION FORM

Date:
Contact Person:
Business Name:
Type of Business:
Business Code
Date Business Formed: (01/01/2001)
Fiscal Year End (12/31)
Street Address:

Mailing Address (if different):

Telephone Number: (713-555-2222)
Ext. (131)
Fax Number: (713-555-2222)
E-mail Address:
Taxpayer (EIN) ID#

 

Type of Entity
Check all Applicable
 Ownership %
Names of Stockholders, Officers,
Sole Proprietors and Partners
 Directors

C-Corp

 %

S-Corp

 %
Professional Association %
Sole Proprietor %
LLP %
LLC %
Other %    
       
   

Name of CPA

E-Mail

Street Address

Suite #
City
State
Zip
Telephone # (713-555-2222)
Ext. (341)
FAX# (713-555-2222)