CONTACT INFORMATION:
Your name:*
Business name:*
Best contact telephone number:*
Alternate number:
Business address:*
Street address
City, state, and zip code:
Mailing address (if different than street address):
Street address or P.O. Box
City, state, and zip code:
Email address:*
Fax #:
If we need to contact you, the best time is:
Select
Morning
Afternoon
Evening
BUSINESS INFORMATION:
Number of employees:*
Year business was established:*
How many locations does your business have?*
Structure of business:*
Select
Sole Proprietorship
Partnership
LLC or LLP
Corporation
Annual gross sales:
Types of products or services your business offers:*
If known, please briefly describe the types of legal
services you foresee your business requiring in the next 12-months:
PAYMENT INFORMATION:*
You may elect to pay the Business Citadel plan retainer
fees in either monthly payments or by a single annual payment. Either
option includes a one-time $55.00 set-up fee. A 5% discount is automatically
applied to the single annual payment option. The monthly or annual
payment options are as follows:
Monthly payments: First payment of $180.00,
eleven monthly payments for $125.00.
Annual payment: One-time payment of $1,425.00 (5% discount applied).
Bank information:*
For your convenience, ACH (electronic check) payment
is available in lieu of mailing in a physical check. Your payment
will be processed by A-E Trade, Inc. The information necessary to
set up an e-check is available from the face of your checks. If you
have selected monthly payments, you may change your bank account information
at any time by logging into your client profile page (instructions
are included with your confirmation letter).
Your business or personal name as printed on your checks:
Address printed on your checks:
Select address or enter new address below:
Select
Same as business address above
Same as mailing address above
Street address or P.O. Box
City, state, and zip code:
Name of bank:
Nine-digit routing number:
Account number:
Authorize a payment amount (including one-time $55.00 set-up fee):
Select
Initial payment of $180.00
One-time payment of
$1,425.00
An ACH debit (e-check) payable to A-E Trade in the amount
authorized will debit from your account no sooner than 3-business
days from today's date. If you have elected to make monthly payments,
11 additional debits for $125.00 will post to your account
each month for your annual Business Citadel plan.