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.