NEW BUSINESS CLIENT EXTENDED INFORMATION DATE: CLIENT NUMBER: CLIENT NAME: ADDRESS:
[Firm Logo]
MAILING ADDRESS:
TELEPHONE NO: FAX NO: EMAIL: PERSONNEL ASSIGNMENT:
( (
) )
-
ENGAGEMENT PARTNER: IN CHARGE: STAFF: ACCOUNTING ASSISTANT:
FISCAL YEAR END: EIN: NAIC CODE: CONTACT(S): PRIMARY BANK/BANKER: ATTORNEY FIRM/ATTORNEY:
NEWSLETTER: TYPE OF ENTITY:
Yes C CORPORATION S CORPORATION PARTNERSHIP PROPRIETORSHIP NON-PROFIT LLC
No TRUST ESTATE GOVERNMENT/MUNICIPALITY EMPLOYEE BENEFIT PLAN OTHER
KEY OWNERS/OFFICERS:
NAME
OWNERSHIP %
OTHER CLIENTS THAT ARE RELATED BY COMMON OWNERSHIP OR CONTROL:
BRIEF DESCRIPTION OF CLIENT’S BUSINESS: 1099 PREPARATION CODE: REFERRAL SOURCE: Prepare Instructions New
[Firm Name] NEW BUSINESS CLIENT EVALUATION CRITERIA ACCEPTANCE CRITERIA: LEAST-MOST 1–5
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Client appears to present high ethical standards. Client possesses growth potential. Client requires or is expected to require varied services provided by firm. Client possesses adequate accounting and internal control systems necessary to gather the information required for the services we are to provide. Client is adequately capitalized. Client's contacts are such that we would expect exposure to other quality clients. Client does not expose us to any unusual degree of legal exposure. Client is agreeable to the firm's billing rates and terms. Client appears accepting and appreciative of professional services. Client is well-informed about his business and the industry in which it operates. TOTAL RANKING MAXIMUM = 50 POINTS ACCEPTANCE CUT-OFF = 35 POINTS
ADDITIONAL CRITERIA TO CONSIDER: Do we possess the expertise necessary to perform the engagement? Do we possess the staffing required to complete the engagement? Are we aware of any disagreement between the potential client and their previous accounting firm regarding accounting principles, tax issues, or fees? If yes, describe: Yes Yes No No
Yes
No
Are you aware of any potential conflicts of interest with other current clients?
List below members of our firm and possible relationships that may cause an independence problem. FIRM MEMBER POSSIBLE INDEPENDENCE ISSUE
CONCLUSION: We should accept or not accept the engagement.
ENGAGEMENT PARTNER: MANAGING PARTNER: