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NEW
CLIENT DATA SHEET |
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NEW
CLIENT AUTHORIZATION |
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Primary Partner
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Active Date
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Second Partner
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Date |
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Client
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| Client/ |
COMPANY NAME:
______________________________________________________________________ |
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| Mailing |
ATTN:_______________________________________________ |
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ADDRESS:______________________________________________________________________________ |
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______________________________________________________________________________ |
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CITY,STATE,ZIP:________________________________________________________________________ |
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| Id/Phone/ |
FED ID/SS
NUMBER:_______________________ |
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| Email |
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PHONE:
______________________
FAX:
_________
EMAIL:
__________________ MOBILE:
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FISCAL YEAR
END:___________ |
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| Profile |
Entity
Type/Industry Type(circle one):Auto Dealer, Bus Val/Litig,
Childcare, Construction, Estate, Firm Non
billable, |
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Healthcare, Individual,
Insurance, Manufacturing, Misc., Not for Profit,
Real estate, recreation, restaurant,
retail, |
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Service other, service
prof., technology, trust, wholesale) |
NAIC /SICCode
____________________________ |
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| Staff |
Primary Partner
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Bill Manager
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| Contacts |
Secondary Contact Name
____________________________________________ |
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This name can be selected
when creating mailing labels and will show up in
contact mgmt |
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| Marketing |
Firm Person Responsible
for Acq. Client
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Referral Responsible
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outside referral source
who helped us in gaining this client |
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Marketing Method
Responsible (circle one) |
Advertisement, AGC,
Attorney Referral, Bank Referral, CFMA, Client
Referral |
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Healthcare Finl. Mgmt.
Assoc., NC Center for NP, NCAPCA,
Unassigned |
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SERVICES |
DUE
DATE |
STAFF
ASSIGNMENT |
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BUDGET |
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1040 |
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1120 |
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1065 |
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5500 |
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Payroll |
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1099 |
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Property |
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Audit |
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Compilation |
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Review |
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Other |
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| 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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| ********************************************************************************************************** |
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| SIGN OFF: |
CPAS |
________ |
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Rolodex |
________ |
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New Client
Notebook |
___________ |
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| ********************************************************************************************************** |
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