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					                                                            CLIENT INFORMATION SHEET
                                                                              DATE 10/25/11
         NEW CLIENT                ONE TIME WORK            EST ANNUAL FEE: $                                   OFFICE:           [Office 1]                  [Office 2]
     CLIENT CODE:                           ENG CODE(S) DESCRIPTION:                                                                          PHONE CODE:
     CLIENT NAME:                                                                 SORT NAME:
     ATTN NAME:                                                                   CLIENT ADDRESS:
     CITY, STATE, ZIP:                                                            MAILING ADDRESS (IF DIFFERENT):
     CITY, STATE, ZIP:                                                            FIN:
                                                                ND
     PHONE NO:                                              2        PHONE NO:                                        FAX NO:
     PRIMARY EMAIL:
     FISCAL YE MONTH: No Selection                    ENTITY TYPE: No Selection               DEPARTMENT: No Selection                     NAIC:
     IS THIS CLIENT ASSOCIATED WITH A MAJOR CLIENT?                               Yes
     PRIMARY PARTNER:                      SECONDARY PARTNER:                            BILL MGR:                 TAX REVR:                  TAX PREP:
         NEW NOTEBOOK                              MAIN      LITIGATION                        VALUATION                  OTHER
                                                GIVE NOTEBOOK TO:   PIC                       OR
     NEWSLETTER:                None            Healthcare            Auto           eNewsletter: email address:
                                                                             OR      Send paper copy            (required for e-newsletter)
     ORIGINATING PERSON:                                    FIRST CO-ORIGINATOR:                                ADDITIONAL CO-ORIGINATOR:

     REFERRAL SOURCE

         EMPLOYEE CONTACT (EC)                              CLIENT REFERRAL (CR)            Name                          CLIENT EXPANSION (CE)

         BANKER REFERRAL (BR)                               ATTORNEY REFERRAL (AR)                                        OTHER REFERRAL (OR) Name


     PROJECTS:
     Check items for due date list:                                                              Estimated hours                            Employee in charge
       1040                         Due 4/15
        709 GIFT RTN                       Due 4/15
        104OES                             Due 4/15, 6/15, 9/15, 1/15
        1120                               Due Date
        1120S                              Due Date
        1065                               Due Date
        1041                               Due Date
        990                                Due Date
        5500                               Due Date
        706 EST RTN                        Due Date
        PROP RTN                           Due 10/01
        QTRLY RTNS                         Due 1/31, 4/30, 7/31, 10/31
        FIN STMTS                          Date Due
        VALUATION
        LITIGATION
        OTHER:                             Date Due

RECEPTIONIST:                                                           OFFICE ASSISTANT:
1.     Assign long distance phone code                                  1.    Prepare notebook
2.     E-mail client/phone code/email address                           2.    File copy of CIS in client's notebook in Permanent File section
3.      Enter client info to time system & make change of address       3.    File notebook on shelf in alphabetical order according to client code
     to ProSys                                                          4.    Type billing label for new client and place on billing folder. File billing folder on
4.      Enter projects in time system                                            shelf (except litigation clients)
5.     Update Smart Label Printers Recep        TSS   KLM               5.    File original CIS in CIS Notebook
6.     Excel New Client Tracking
7.     Send Privacy Act letter to Individuals
                         CLIENT INFORMATION SHEET (Continued)
This information should be completed for all potential clients including business tax engagements, MAS
engagements, litigation support engagements, valuation engagements, compilations, reviews and audits.

If you are aware of any reason we should not accept this engagement, including independence
issues, please notify the partner-in-charge immediately. In addition, if you believe you may be of
assistance in obtaining the client, please contact the partner-in-charge.

Briefly describe the client's business.



List the principal owners, members of management and key accounting personnel.



Briefly describe the services our firm is to perform.



If financial statements are to be prepared, to whom will they be distributed?



Summarize our fee arrangement and note if there are potential collection problems.

				
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