New Client Questionnaire

Client's Name: *

Spouse's Name:

Home Address: *

City: *

State: *

Zip: *

Home Phone: *

Work Phone:

Cell Phone: *

Spouse's Cell Phone:

Email Address: *

Spouse's Email Address:

Client DOB: *

Spouse DOB:

Client's SSN:

Spouse's SSN:

Dependents Name (s) and DOB:

AREAS OF INTEREST (Please check all that apply):


Tax PreparationTax Planning & Tax AnalysisIRS Representation – Problems & Resolutions


Accounting/Bookkeeping servicesEntity Selection Analysis (LLC, C-Corp, S-Corp)Payroll Services – Analyze the OptionsStart-up QuestionsCredit Card Processing DiscountsGeneral Business Consulting


Review of GoalsRetirement Planning401K RolloverTax Deferral – Business (SEP, SIMPLE, IRA, 401k, other)Social Security


Quote Personal Lines Insurance (Homeowners, Auto, Flood, Umbrella)Quote Commercial Lines Insurance (Liability, Workers Comp, Auto, Umbrella, Commercial Property, Malpractice, E&O, Professional)Quote Health/Life InsuranceQuote Boat/Marine/RV/ATV/Golf Cart

Questions, concerns or changes in your financial or business status:

***If you have it, please provide a copy of your past year’s individual and business (if any) tax return***
(If you are unable to upload at this time, please bring a physical copy to your meeting)