Financial Intake Form
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Please choose which one do you want to be contacted by
Phone
Email
Both
Other
Company Information
Company Name
Company Website
Company Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please briefly explain what your company does (include products your sell or services you are paid for.
Starting date of your company
-
Month
-
Day
Year
Date
What is your title?
Number of employees you plan to hire in the next 12 months
How may contractors you plan to hire in the next 12 months
Do you file or plan to file estimated taxes?
Yes quarterly
no, end of the year
What is your budget for financial management?
Do your own bookkeeping/accounting
Do your own tax filing
Hire a staff to manage your finance
Hire a professional to do your bookkeeping/accounting
Hire a professional to file your taxes
Get DIY (Do-it-yourself) training
Total Monthly Financial Management Budget
Enter a dollar amount
Accounting Information and Needs
What accounting software are you familiar with?
If QuickBooks, please indicate Desktop or Online
What Payroll software are you familiar with?
Estimate number of check/debit transactions from your business bank statement, credit card statements, cash receipts will have each month?
Entert the total # of transactions
What will you need the software or professional to offer?
Ability to pay bills with merchant accounts
Accept online payments
Ability to write checks
Payroll for employees
Payroll for contractors
Prepare W2', 1099's other income reporting forms
Financial Statements
Please select the options below that may apply to you for saving time and money
Collecting sales tax
Tracking inventory in a software
Paying Estimated Taxes
Tracking mileage
Approximately, how many invoices will you generate each month?
Do you have any experience working with a financial management professional?
Yes
No
Qualifying Revenue. On an average, the small business owner should allocate 5% of their annual gross revenue for bookkeeping and/or financial services. Example if you gross $100,000 a year, $5000 should be included in your budget annually or monthly depending upon the amount of service hours you may require. This equate to an average of $417 per month for financial management. Is this average amount within your range?
Yes
No
Not sure/ Not yet
Please select a quote you are requesting for the services you need in the next 90 days
Client Billing
Financial Statements
Year End Tax Package
State Tax Reporting
Business Start-Up Assistance
Monthly Account Reconciliation
Budgeting/Forecasting
Transaction Entry
Payroll
Business Consulting
Contract Management
Cash Flow Reporting
Bill Pay
City Tax Reporting
Other
Additional information we should know
Please verify that you are human
*
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