Main Office: 7747 E. Rosecrans Avenue Paramount, CA 90723 mngmnt@staubmetals.com Phone: (562)602-2200 Fax: (562)633-1456 DATE : FIRST NAME : PHONE : STREET ADDRESS : CITY, STATE, ZIP : TYPE OF BUSINESS : BUSINESS START DATE : RESALE # : CORPORATION PARTNERSHIP INDIVIDUAL IF A CORPORATION, UNDER WHAT STATE LAW IS IT INCORPORATED? IF A CORPORATION, IS COMPANY A SUB CHAPTER "S" CORPORATION FOR FEDERAL INCOME TAX PURPOSES? YES NO NAME : POSITION : RESIDENCE ADDRESS : % OF OWNERSHIP : CITY, STATE, ZIP : INDIVIDUALS LISTED SHOULD COVER AT LEAST 80% OF OWNERSHIP; IF ADDITIONAL SPACE IS REQUIRED , PLEASE LIST IN THE "REMARKS" SECTION BELOW.