NEW CLIENT DATA SHEET
Client Number
NEW CLIENT AUTHORIZATION Primary Partner ________ Second Partner ________ Active Date ________ Date ________
Client/ Mailing
COMPANY NAME: ______________________________________________________________________ ATTN:_______________________________________________ ADDRESS:______________________________________________________________________________ ______________________________________________________________________________ CITY,STATE,ZIP:________________________________________________________________________
Id/Phone/ FED ID/SS NUMBER:_______________________ Email PHONE: ______________________ FAX: _________
EMAIL: __________________ MOBILE: ___________
FISCAL YEAR END:___________ Profile
Entity Type/Industry Type(circle one):Auto Dealer, Bus Val/Litig, Childcare, Construction, Estate, Firm Non billable, Healthcare, Individual, Insurance, Manufacturing, Misc., Not for Profit, Real estate, recreation, restaurant, retail, Service other, service prof., technology, trust, wholesale) NAIC /SICCode ____________________________
Staff
Primary Partner
____________ ____________
Bill Manager ___________
Contacts Secondary Contact Name ____________________________________________
This name can be selected when creating mailing labels and will show up in contact mgmt
Marketing Firm Person Responsible for Acq. Client ____________
Referral Responsible __________________ Marketing Method Responsible (circle one)
outside referral source who helped us in gaining this client Advertisement, AGC, Attorney Referral, Bank Referral, CFMA, Client Referral
Healthcare Finl. Mgmt. Assoc., NC Center for NP, NCAPCA, Unassigned
SERVICES 1040 1120 1065 5500
Payroll
DUE DATE ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______
STAFF ASSIGNMENT ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________
BUDGET ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______
Projects
1099
Property Audit Compilation Review Other
Mailers
Monthly newsletter Yes/No
Thank you letter Yes/No Privacy letter Yes/No (Add Tax Client Address and Ind. Or Bus. File labels)
********************************************************************************************************** SIGN OFF: CPAS ________ Rolodex ________ New Client Notebook ___________ **********************************************************************************************************