Client Intake Form 2021

Business Intake Form

PLEASE FILL OUT ALL INFORMATION APPLICABLE
Client Name*

First NameLast NameSuffix
Social Security Number*
Date of Birth*

MonthDayYear
Occupation*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
File Upload

Example: Government ID, Drivers License, Passport, Social Security Card, Birth Certificate
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Home Address*

NO P O BOX/ PHYSICAL ADDRESS ONLY

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Partner (if any)

First NameLast NameSuffix
Social Security Number
Date of Birth

MonthDayYear
Occupation
Email
example@example.com
Phone Number
Please enter a valid phone number.
Business Address

NO P O BOX/ PHYSICAL ADDRESS ONLY

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you own or rent the location?

RentOwnOther
Do you have any of the following docs?

LeaseUtility BillMortgage Statement
Upload your Document:

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This form is for intake purposes only!

DO YOU HAVE A BUSINESS? ANSWER THE QUESTION SPECIFIC TO YOUR BUSINESS ENTITY REGISTERED WITH THE SECRETARY OF STATE:*

YES (SOLE PROPRIETOR)YES (LLC)YES (S OR C CORP)YES (OTHER)NO
UPLOAD ANY PROOF OF INCOME, OUT OF POCKET EXPENSE, EIN, OR ARTICLE OF CORPORTATION PERTAINING TO YOUR BUSINESS.

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Would You like a quote for Commercial General Liability Ins.*

YESNO
Coverage Amount$ (if yes)
Business Name:
EIN if Available
Type of Business:
Example: lash tech, landscaper, hairstylist
I WAS REFERRED BY:
How did you hear about us?*
I understand that this information is needed to process my request for assistance. AR Financial and/or A Tax Services will not be held liable for any associated penalties, audits, or fines as it relates to compliance.
Signature*

Clear
Date

MonthDayYear
Should be Empty:

Business Intake Form