Become a Client New Client Intake Form 1 Client Info2 Entity Information3 Officer Information4 Needs Assessment General InformationName First Last Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Office/Home PhonePrimary CellWorkSecondary CellWorkPrimary Email Secondary Email Entity InformationLegal NameDBAAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Business Activity TypeType of EntitySole ProprietorPartnershipS-CorporationC-CorporationLLCDate of Incorporation Tax ID NumberCalendar of Fiscal Year?CalendarFiscalIf fiscal, what is year end? Gross Yearly RevenueNumber of Employees Officer InformationOfficer 1 NameOfficer 1 TitleOfficer 1 % OwnershipOfficer 2 NameOfficer 2 TitleOfficer 2 % OwnershipOfficer 3 NameOfficer 3 TitleOfficer 3 % OwnershipOfficer 4 NameOfficer 4 TitleOfficer 4 % OwnershipOperationsPlease provide a brief overview of your business goals:What are your top 3 business issues/problems? Why ELAC?1. How did you hear about us?2. Have you used a Trusted Business Advisor or CPA in the past? If so, who?3. Why are you looking to make a change or seeking the services of our firm?4. What services are you interested in? Business Tax Return (Corporate / Partnership / Non-Profit) Financial Statements (Compiled / Reviewed / Audited) Bookkeeping Payroll / Payroll Taxes Sales Tax / Solid Waste Tax Business Valuation Consulting (Strategic / Financial / HR / Operations / Marketing) Individual Income Tax Return 5. How quickly do you need us to begin providing the services checked above?6. Do you use any form of accounting or tax software now? Yes No 6b. Which software?ExcelQuickBooksPeachtree7. What are your expectations of our firm?How frequently would you like your Trusted Business Advisor/CPA to contact you?What is your preferred form of communication?PhoneEmail10.Have you ever used consulting services to improve your business? Yes No Other comments, questions, concerns, or needs: