Your Name:

Title/Position:

Company Name:

Phone number:

E-mail address:

Address 1:

Address 2:

City:

State:

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Zip Code:

In order to provide you with a proposal, we will need to know some information. Please provide us with the following information about your Company and your Plan:

Plan Type:

select ESOP KSOP

Number of participants:

Corporate Tax Structure:

select C-Corp S-Corp

Is the ESOP currently leveraged?:

select Yes No

Does the ESOP hold more than one class of stock? (i.e. voting, non-voting, common, preferred, etc.):

select Yes No

Are contributions allocated based upon compensation?:

select Yes No

What other plans do you sponsor? (e.g. Davis Bacon, defined benefit, etc.):

I am particularly interested in the following aspect(s) of ESOPs:

Administration

Employee/Participant Meetings

On-line access

RLS Direct™ (Repurchase Liability Studies)

Please call me. I have some questions about ESOP’s in general.

Comments/Questions: