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QUESTIONNAIRE FOR EIN FOR SS-4 / FEDERAL I.D. #

Your E-mail Address:
  1. Name of Principal Officer, General Partner, Grantor, or Trustor:
    S.S.#

  2. Reason for applying:


  3. First date wages or annities were paid or will be paid. (best estimate)
    Month, Day, Year: ,

  4. Enter highest number of employees expected in the next 12 months: (best estimate)

  5. Is the principal business activity manufacturing? Yes No
    If Yes, principal product and raw material used:
    Type of Business:

  6. To whom are most of the products or services sold? (you may answer more than one)
    Business (wholesale):
    Public (retail):
    Other:

  7. Has the applicant ever applied for an identification number for this or any other business?
    Yes No (if Yes, give:)
    Legal name:
    Trade name:
    (if different than name shown on prior application)

    Approximate date when filed:
    Month, Day, Year: ,
    City and State where filed:
    Previous EIN #:


Securities offered through Registered Representatives of ROGO Capital LLC
Member: FINRA SIPC MSRB

H. A. INCORPORATED
Corporate Headquarters
308 NW 101 Terrace
Coral Springs, FL  33071
Phone: (954) 752-7520
E-Mail: info@hellercap.com


Copyright © 1976 H. A. INCORPORATED
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