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The Alan Kemp Group
400 Continental Blvd., 6th Floor, Suite 117
El Segundo, CA 90245
Phone: 310-426-2344 Fax: 310-426-2756
email: customerservice@alankempgroup.com
www.alankempgroup.com

CLIENT PROFILE

Contact Person:

Name:	Phone	Numbers:
Address 1:	Home:
Address 2:	Office:
City:	Fax:
St:	Cellular:
Zip Code:	Pager:
Social Security Number:	Emergency:
Date of Birth:

Business Information:

Name:		Mailing:
Address 1:		Address 1:
Address 2:		Address 2:
City:		City:
St:		St:
Zip Code:		Zip Code:
Phone:		Fax:
Backline:

Type of Business:

Sole Proprietorship
Initial Investment:
Contribution:
Partnership
Number of Partners:
Partner Name:
Partner's Initial Investment:
Corporation
Date of Corporation:
State of Corporation:
Corporation State ID#:
Corporate Officers:
No. of Shares Authorized:
Distributed Shares:
No. of Share Holders:

ID Numbers:

Federal ID No:		State ID No:
Business SIC No:

Business Activity:

Principal Business Activity:
Principal Product or Service:
Date Business Established:

Type of Accounts:
Current Savings	Money Market
Name of Banks:
1.
2.
3.
Current / Beginning Balances:
Cash:
Accounts Receivable:
Inventory:
Security:
Bonds:

Tax Returns - Last Filed:

1996 Fed:		State:
1997 Fed:		State:
1998 Fed:		State:

List of Assets:

Description	Date Incurred	Balance

The Alan Kemp Group
400 Continental Blvd., 6th Floor, Suite 117
El Segundo, CA 90245
Phone: 310-426-2344 Fax: 310-426-2756
email: customerservice@alankempgroup.com

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