BOOKKEEPING CLIENT INTAKE FORM

DISCLAIMER: Thank you for your interest in being a client of __________________. Information collected about new clients is confidential and will be treated accordingly.

GENERAL INFORMATION

Name: __________________  Address: ____________________
Phone: ____________________ Email: ____________________

ENTITY INFORMATION

Legal Name: ____________________ Address: ____________________
Primary Business Activity/Type: ______________________________
☐ Sole Proprietor ☐ Partnership ☐ S-Corp ☐ Corporation ☐ LLC ☐ Individual
Date of Incorporation: ___________ Tax ID: _______________________
☐ Calendar Year ☐ Fiscal Year -If fiscal, what is year-end? ______________
Gross Yearly Revenue: $________________  Number of Employees: _____

OFFICER / OWNER INFORMATION

Name                        Title                              Ownership Percentage
________________ __________________     _________%
________________ __________________     _________%
________________ __________________     _________%

CPA / TAX ACCOUNTANT INFORMATION

Name: ____________________________   Telephone: ________________
Address: __________________________

INTAKE ASSESSMENT

My financial statements are current.
☐ 0 ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5
I understand my financial statements.
☐ 0 ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5
I use KPIs to measure my business effectiveness in various areas.
☐ 0 ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5
My cashflow is good and easily meets business demands.
☐ 0 ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5
My accounting procedures are well documented in the Operations manual.
☐ 0 ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5
I review liquidity, leverage, efficiency, and profitability ratios regularly.
☐ 0 ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

How is your bookkeeping being done at present?
What financial goals have been established?
What changes would you like to see in your bookkeeping process?

ACKNOWLEDGMENT

Signature: _________________________ Date: ___________
Printed Name: _______________________