BLACK TAX OFFICES
REQUEST FOR CONSIDERATION

PERSONAL INFORMATION

Date of Birth: *
Date of Birth:
US Citizen: *
Phone *
Phone
Home Ownership: *
Marital Status *
Spouse DOB
Spouse DOB
Spouse US Citizen:
Do you plan to have business partners? *
If yes, Please identify them below and their ownership interest:
Partner 1
Partner 1
Partner 2
Partner 2
$
$
Would this business be your only source of income? *
Are you now, or have you ever been party to any lawsuit – either as defendant or plaintiff? *
Have you ever been convicted of a felony? *
Have you or any company you have owned or managed ever filed for bankruptcy, reorganized due to insolvency, gone out of business, or compromised a debt? *
Question 1:
Question 2:
Question 3: