New Customer Registration Form

Customer Details:

Full Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Format: (000) 000-0000.

E-mail

example@example.com

How did you hear about me?

If "Other", Please Specify

Tell me about you! The more personal details you're willing to divulge, the better I can assist you. Any information you share here is strictly Confidential. I want to know as much as I can about you for logistical purposes. I can work best for you if I have a complete idea of who you are and how you operate, what you like and don't like, etc. For example, what type of cell phone do you use? Apple iOS or Android? What kind of car do you drive? How do you feel about technology? What type of food do you like? What is something you can't tolerate? What is your family life like? What are your hobbies? Please be candid. The more I know, the better!

What type of business are you in? Tell me all about that....

What's your official occupation (Title)?

Do you own your own business?

If you own your own business, what is the name of your business? (or Former Business Name if it is closed)

If you own your own business, are you the sole owner?

Choose the services you would like help with (Select as many as apply):

If you selected "Other" above, please specify:

Your personality type is: (Select as many as apply)

If you selected "Other" above, please specify:

In the book "The Four Personality Types" as it relates to animals: You relate most with:

Do you have minor children?

What is your relationship status?

When do you need help?

What is your age range?

What is your income range? (Gross household income)

What's your typical schedule like? What are the best days for you and I to get about 30 minutes of uninterrupted time, or for someone that I refer to you to speak with you? Feel free to write: "Just call - if I can talk, I'll let you know" if you want. Otherwise, even listing out a general schedule helps me a lot!

Any other comments?

My first 1-hour phone consultation is complimentary. If you choose to hire me after that, my general pricing is:

$75 per referral or new booking
$75/hour for micro-tasks or bookkeeping services (1-hour minimum)

New micro-task concierge clients pay a one-time, non-refundable $75 admin fee to get started. This is a setup fee and is not applied toward your first hour of work.

New bookkeeping clients—and micro-task clients who work with me more than once or on an ongoing basis—pay a one-time, non-refundable $500 admin fee before work begins. This is also a setup fee and is not applied toward your first hour.

Billing is handled through QuickBooks Online invoicing, which accepts all major credit cards and other electronic payments. Invoices are due upon receipt and considered delinquent after 30 days. For bookkeeping clients, I typically submit and process invoices immediately as a general contractor in QuickBooks. If there’s ever an issue, just let me know.

These fees help cover monthly memberships, digital tools, office supplies, and other business expenses.

I provide a simple PDF agreement for every client who hires me.

What sets me apart:

I am not an employee (I work on a 1099 or cash basis)
I am available to you virtually anytime

I do take Sundays off, but otherwise I’m flexible and available—even for late calls. I offer a highly personalized experience and can provide excellent references.

Please check this box to assure me that you've read the terms above.

True or False: I definitely know at least one other person who could use your help.

All information submitted on this form is strictly confidential and is fully encrypted by Jotform and is not seen by anyone except the recipient (Ann Shrader). Please check this box to affirm that you understand this.

i-Coastal Bookkeeping & Micro-task Administrative Concierge Services

New Customer Registration Form

Personal Questions

General Pricing & Payment Terms