CTA Inquiry Form - Fisher, Tousey, Leas & Ball, P.A.

Corporate Transparency Act ("CTA") Inquiry Form

Your name

Phone number

Your company's legal name

What state or jurisdiction is your company organized under?

Please list every individual or entity that has an ownership stake in your company:

Please list every individual who is a manager, director, or senior officer in your company

DISCLAIMER

IMPORTANT: The purpose of this inquiry form is to (1) provide us with sufficient information to determine whether a conflict in representing you may exist and (2) consent to our follow up with you by email or telephone (which, unless we are engaged by you pursuant to an engagement agreement, will be without charge). Submitting this inquiry does NOT establish a relationship or constitute an agreement to represent you in any capacity. As such, no attorney-client privilege will be established beyond the information contained in this inquiry. If you would like to engage us for services or other confidential information, including assistance with FinCEN filing, you will be required to sign an engagement letter specifying the services to be rendered.

Corporate Transparency Act ("CTA") Inquiry Form

Jacksonville

Ponte Vedra Beach

Amelia Island

St. Johns County