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

Click filename below to access file

New Individual Client Information.xls




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