Business Tax Intake Form

Weafers Tax Service

Business Tax Intake Form

853 Lane Allen Rd., Lexington, KY 40504

Main Line: 859-281-1040 - Text Line: 859-286-4540 - Fax: 866-884-6296

Email: docs@weafertax.com
1. Business Profile
Legal Business Name (DBA, if applicable)*
Type Full Business Name
Physical Address*
Business Address
Mailing Address (If different)
Business Mailing Address
Mobile Phone*
Main Business Phone
Email*
Best Business Email
Business Activity Industry*
Your Business's Industry
Date of Formation*

MonthDayYear
Date Of Formation
Primary Contact Name and Title*
2. Ownership/Members
Full Legal Name*
Member/Manager/Owner Full Legal Name
Date of Birth*

MonthDayYear
Member/Manager/Owner Date of Birth
Social Security Number*
Member/Manager/Owner Social Security Number
Occupation*
Member/Manager/Owner Occupation
Address*

Member/Manager/Owner Physical Address

Street Address Line 2

CityState

Postal / Zip Code
ZIP*
Member/Manager/Owner Physical Zip Code
Mobile Phone*
Member/Manager/Owner Mobile Phone Number
Email*
Member/Manager/Owner Email Address
Ownership %*
Member/Manager/Owner Ownership Percentage
Social Security Number*
Member/Manager/Owner Social Security Number
2. Ownership/Members Cont... (Second Owners' Info)

Use Only For Business's With More Than One Owner (Skip Section If Only One Owner)
Full Legal Name*
Member/Manager/Owner #2 Full Name (Skip If Not Applicable)
Date of Birth*

MonthDayYear
Member/Manager/Owner #2 Date of Birth (Skip If Not Applicable)
Social Security Number*
Member/Manager/Owner #2 Social Security Number (Skip If Not Applicable)
Occupation*
Member/Manager/Owner #2 Occupation (Skip If Not Applicable)
Address*

Member/Manager/Owner #2 Physical Address (Skip If Not Applicable)

Street Address Line 2

CityState

Postal / Zip Code
ZIP*
Member/Manager/Owner #2 Physical Zip Code (Skip If Not Applicable)
Email*
Member/Manager/Owner #2 Email Address (Skip If Not Applicable)
Mobile Phone*
Member/Manager/Owner #2 Mobile Phone Number (Skip If Not Applicable)
Ownership %*
Member/Manager/Owner #2 Ownership-Percentage (Skip If Not Applicable)
3. Tax Identification Numbers
Federal EIN
Employer Identification Number (EIN) (Leave Blank If Unsure)
Secretary of State
Secretary Of State Account (SOS) Acct Number: (Leave Blank If Unsure)
LLET/CIT Account Number
Departments Of Revenue Account Number (Leave Blank If Unsure)
Local Occup License Account Number
Local Occup. License Account Number (Leave Blank If Unsure)
Withholding Tax Account Number
Payroll W/Holding Account Number (If applicable) *(Leave Blank If Unsure)
Sales Tax Account Number
Sales Tax Account Number (If applicable) (Leave Blank If Unsure)
NAICS Code
Industry Code (Leave Blank If Unsure)
4. Business Structure

Consult With our Firm (Will be discussed before Legal Entity is Established)
Business Structure:*

Sole ProprietorshipCorporationCooperative/Joint VentureSingle-Member LLCLLC/S-CorporationPartnership/Multi-Member LLC)Trust/Estate
5. Accounting & Services
Accounting Method

CashAccural
Current Payroll Provider:
If Applicable
Current Bookkeeping Software (If applicable)
Services Requested:*

PayrollBookkeepingSales TaxAccountingNew Business FormationBusiness Tax PreparationPersonal Tax PreparationAdvisory
Additional Notes/Comments
Tax Accountant Requested:
• Manny | Aaron | Travis | Justin | Steve | No Preference •
I certify that the information provided above is accurate and complete to the best of my knowledge.
Client Signature and Date*

Clear
Full Legal Name*
Please Type Full Name
Weafers Tax Service I Office (859) 281-1040 I Fax (866) 884-6296 I docs@weafertax.com
Should be Empty:

1. Business Profile

2. Ownership/Members

2. Ownership/Members Cont... (Second Owners' Info)

3. Tax Identification Numbers

4. Business Structure

5. Accounting & Services