REQUEST FOR SERVICES
Name
Occupation/Industry
Telephone
Format: (000) 000-0000.
Email
example@example.com
How did you hear about us?
Name of former accountant
Reason for the switch
What services are you requesting (check all that apply):
Income Tax Return Preparation
Bookkeeping
Sales/excise tax return preparation
Payroll processing
Quarterly Payroll Report (941/940/W-2/W-3) preparation
Other
Who are you requesting services for (check all that apply)?
Yourself (and spouse)
Trust/Estate
Business
If a business, name of your bookkeeper
If a business, name of your payroll provider
If a business, does your business file it’s own tax return that is separate from your personal return?
How would you like to receive your invoices and/or statements (check one)?
Electronic
Paper
COMPLETE THE FOLLOWING SECTION IF YOU ARE REQUESTING BOOKKEEPING SERVICES
How many bank accounts does your business have?
How many loans do you have?
If we will be preparing sales/excise tax returns, how often do you file (monthly, quarterly, etc)?
What month will we be taking over your bookkeeping?
COMPLETE THE FOLLOWING SECTION IF YOU ARE REQUESTING PAYROLL SERVICES
How many employees do you have?
How often do you pay your employees every 2 weeks, twice per month, etc
Are you required to garnish your employees’ wages child support, etc?
Do you give any loans to your employees?
Benefits provided to employees (check all that apply)
Retirement Plan
Health/Dental/Vision Insurance
Health Savings Account (HSA)
Dependent Care
When would you like us to start processing your payroll?
Other Notes or Comments
Submit
Should be Empty: