[Firm Name ] New Individual Client Information
Client ID Number:
Bill to client # : Biller:
Preparer s/o
Client Name:
Shareholder: Group: Set-Up Date:
Basic Client Information
Address:
Street or PO Box
Tax Filing States
2nd Line Street
City
State
Zip Code
(Please check all that apply)
Home Telephone:
Fax:
AL AK AZ AR CA CO CT DE DC FL GA HA ID
IL IN IA KS KY LA ME MD MA MI MN MS MO
MT NE NV NH NJ NM NY NC ND OH OK OR PA
PR RI SC SD TN TX UT VT VA WA WV WI WY
email address:
Individual:
SS #: Place of Business:
DOB:
Ofc Phone:
Spouse:
SS #: Place of Business:
DOB:
Ofc Phone:
Children:
D/S D/S D/S D/S D/S
DOB: DOB: DOB: DOB: DOB:
SS#: SS#: SS#: SS#: SS#:
Other Dependents:
Relationship: Relationship: Relationship: DOB: DOB: DOB:
Affiliated Businesses
Other Comments
Prior Accountant Address
Phone
Client Attorney Address
Phone
Referred by Company
Engagements (please check all that apply)
Assurance Services Audit Business Valuation Consulting Governmental Acctg Litigation Mgmt Advisory Services Non-profit Non-Traditional Engagement Pension Plan Audit Personal Property Tax Retirement Plans Review Services SEC Practice Client Write-Up & Compiliations PENDING - UNKNOWN Audit-401(k) Other Tax - C Corporation Tax - Child Tax - Estate Tax - Fiduciary Tax - Foreign Sales Corp Tax - Gift Tax - Individual Tax - Ptr Tax - S Corporation
Anticipated Staff Assignments / Estimated Budgeted Hours
Ticklers:
Year
Billing/Master File
Client Network Folder
Update Needed Yes No
By
Completed Date [Name ] [Name ] [Name ] [Name ] [Name ] [Name ] [Name ]
Set-up
Description
Campaign?
Front Desk Rolodex Secretarial Rolodex Shareholder Rolodex CRM Marketing Codes PC (postcard) TX (tax letter/booklet) FO (Foundation) Set-up Scanned X
1040 Individual State Individual State Individual
State
[Name ]
Please return this form to [Firm Administrator ] for scanning.