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PMG Business Assessment Submission Form
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* Indicates required question
First Name:
*
Your answer
Last Name:
*
Your answer
Email Address:
*
Your answer
Contact Number:
*
Your answer
State of Residence:
*
Your answer
Do you have any dependent(s) under age of 18? If Applicable.
*
Yes
No
Employment Status.
*
Full-Time
Part-Time
Contractor
Unemployed
Most recent year of filed Tax Return.
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Your answer
Reported income amount from most recent year of Tax Return.
*
Your answer
Do you own any business(es)?
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Yes
No
If you own a business, what industry is it in?
Your answer
Estimated yearly business revenue.
Your answer
Estimated yearly business income.
Your answer
Additional business notes:
Your answer
Any additional notes you would like to submit:
Your answer
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