NEW CLIENT DATA SHEET NEW CLIENT AUTHORIZATION

Primary Partner ________ Active Date ________

Second Partner ________ Date ________
Client Number

Client/ COMPANY NAME: ______________________________________________________________________

Mailing ATTN:_______________________________________________
ADDRESS:______________________________________________________________________________
______________________________________________________________________________
CITY,STATE,ZIP:________________________________________________________________________

Id/Phone/ FED ID/SS NUMBER:_______________________

Email
PHONE: ______________________ FAX: _________ EMAIL: __________________ MOBILE: ___________

FISCAL YEAR END:___________

Profile Entity Type/Industry Type(circle one):Auto Dealer, Bus Val/Litig, Childcare, Construction, Estate, Firm Non billable,
Healthcare, Individual, Insurance, Manufacturing, Misc., Not for Profit, Real estate, recreation, restaurant, retail,
Service other, service prof., technology, trust, wholesale) NAIC /SICCode ____________________________

Staff Primary Partner ____________ Bill Manager ___________

Contacts Secondary Contact Name ____________________________________________

This name can be selected when creating mailing labels and will show up in contact mgmt

Marketing Firm Person Responsible for Acq. Client ____________

Referral Responsible __________________ outside referral source who helped us in gaining this client
Marketing Method Responsible (circle one) Advertisement, AGC, Attorney Referral, Bank Referral, CFMA, Client Referral
Healthcare Finl. Mgmt. Assoc., NC Center for NP, NCAPCA, Unassigned

SERVICES DUE DATE STAFF ASSIGNMENT BUDGET

1040 ______ ____________________ ______

Projects 1120 ______ ____________________ ______
1065 ______ ____________________ ______
5500 ______ ____________________ ______
Payroll ______ ____________________ ______
1099 ______ ____________________ ______
Property ______ ____________________ ______
Audit ______ ____________________ ______
Compilation ______ ____________________ ______
Review ______ ____________________ ______
Other ______ ____________________ ______

Mailers Monthly newsletter Yes/No Thank you letter Yes/No Privacy letter Yes/No (Add Tax Client Address and Ind. Or Bus. File labels)

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SIGN OFF: CPAS ________
Rolodex ________ New Client Notebook ___________
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