Client Intake Form For CC & Associates Financial

Please complete this form to request professional services from CC & Associates Financial. This intake allows us to understand your needs and contact you with next steps. Submitting this form does not create a client relationship until services are confirmed.
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Best Way to Contact

PhoneEmail
Best Time to Contact You*

MorningAfternoonEvening
For more information, please visit our website: www.ccandaf.com
Client Intake Form

Please provide your personal and business details to help us understand your needs and goals.
Full Legal Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Personal Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Business Legal Name*
Business Start Date*

MonthDayYear
Date
State Where Business is Registered*
Business Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Does your business have a business bank account?*

YesNo
Which services are you interested in? (Select all that apply)*

AccountingBookkeepingPayrollBusiness Tax ReturnsSales Tax FilingBusiness StarterBusiness ConsultationOther
State(s) where sales tax is collected
State
State 2
State 3
Are you a starting a business?*

YesNo
Industry*
What are your business financial goals for the next 5 years?*
What are your personal financial goals for the next 5 years?*
I understand this form is an intake request and services are not confirmed until CC & Associates Financial contacts me.*

I acknowledge
I understand that certain services require an upfront retainer or deposit before work begins.*

I acknowledge
Should be Empty: