Amy Knows Numbers

Consulting Intake Form

Client/Client Company_______________________________________________________________ Initial Consultation: First Visit: F SB SP SpP Co MP Client/Client Company: Address City Contact Person, Position: Spouse (for Family): Phone: Fax: Preferred Method of Contact: Nature of Business (if applicable)?: Federal Id# or SSN: # of Employees (or family members): Sole Proprietorship Corp Partnership Non-Profit

App QB

Payment Information EFT Authorization Date: Routing Number: Account Number Transfer Date: Amount: Payment Frequency: Accounting Budget Per Month:

Referred By: Thank you sent: Contract Signed:

N N

State

Zip

Cell: Email: Best Time to Reach:

S Corp LLP

Name(s) of owner(s), partner(s), or proprietor(s): Name: Address: City Phone: Fax: Name: Address: City Phone: Fax:

Name of CPA/Tax Accountant: Name: Address: Phone:

Y Y

City: Fax:

# of Years in Business: Annual Revenue/Income: LLC Family Individual Other

Title: State: Email: Title: State: Email:

% ownership? Zip % wnership? Zip

State: Email:

Online Bill Payment: Client Set Up Date: Verification Date: First Payment Date: Amount: Payment Frequency: Estimate of Services:

Zip:

Y

N

Date________________