FMA, CPA Client Company Intake Form - Business Advisory and Accounting Partners Business Advisors

Registered Business Name

Assumed Name (or DBA)

BUSINESS REGISTERED ADDRESS:

(PO Box is not allowed)

Street Address

City

State

Zip Code

Best Phone

Email

BUSINESS TAX ID NUMBERS:

Please provide your federal, state, and state unemployment numbers.

Federal ID

State ID

State UC

Business Activity

Business Bank Name

COMPANY PRIMARY CONTACT FOR FMA, C.P.A. INFORMATION:

NOTE: The primary contact’s email address and mailing address will be used for all FMA correspondence and sensitive tax information

Client (First, MI, Last)

DOB

SS

Home Address

Home City

State

Zip Code

COMANY EMAIL ADDRESSES:

Please read our email policy.

Primary Email

2nd Email

3rd Email

Email Address Policy: We require a valid, working email address.
The PRIMARY EMAIL is our mailing address where sensitive tax material may be sent. You will need to check your email periodically for important due dates and information we send.

COMPANY PHONE NUMBERS:

Please check the box to indicate your preferred contact number.

(Select Yes in at least one field)

Business Phone

Main #

Cell Phone	Main # Belongs To	Preferred to Contact

BUSINESS IN OTHER STATES:

Do you collect sales tax and do you know if you are compliant with all sales tax laws?

Does your business conduct business in another state?

Yes

No

If Yes, please provide state name and description:

SALES TAX:

Do you collect sales tax and do you know if you are compliant with all sales tax laws?

Yes

No, I do not have taxable sales

I don’t know if I am compliant

If Yes, what frequency:

Payroll:

Who is your payroll provider/processor?

Payroll: Who is your payroll provider/processor?

EMPLOYEES OF YOUR BUSINESS:

This does not include you, your spouse, or independent contractors.

EMPLOYEES OF YOUR BUSINESS:

None, No other employee

Yes, We have other employees

Number of Full Time EEs

Number of Part Time EEs:

Benefits Provided:

YOUR SPOUSE AS AN EMPLOYEE: Does your spouse currently work for you in your business?

Yes

No

If Yes, please describe duties

CHILDREN AS EMPLOYEES: Do your children currently work for you in your business?

Yes

No

If Yes, please describe duties

INDEPENDENT CONTRACTORS: Please provide information about any independent contractors you pay for services (1099)

None, No independent contractors

Yes, We pay independent contractors

Approx. payment you do to contractors

Do you make payments for services to a personal name?

Yes

No

Unsure

Do you have a written contract in place?

Yes

No

Unsure

Do you issue 1099s to the contractor and the IRS?

Yes

No

Unsure

Does your company have a written expense reimbursement policy for owners and employees?

Yes

No

How are you currently reimbursing yourself for expenses paid personally?

Do you have a corporate or personal credit card that you use exclusively for business purposes?

Yes

No

HEALTH INSURANCE PREMIUMS:

How are your insurance premiums paid?

We pay our own premiums

Personally

Paid by Company

Paid through spouse’s employer

Describe:

If you have other employees: Do you provide health insurance coverage? (Not including you or your spouse)

Yes

No

Unsure

Describe:

HEALTH SAVINGS ACCOUNTS: Are you eligible to contribute to an HSA account with your insurance plan?

Yes

No

Unsure

If Yes, Are you funding your HSA?

Yes

No

OTHER:

Is funding your retirement account a priority to you?

Yes

No

Unsure

Do you have other employees eligible for contributions?

Yes

No

Unsure

Are you interested in learning how to self-direct retirement funds?

Yes

No

Unsure

AUTOS USED FOR THE BUSINESS:

Describe each auto used by the business. Let us know the name on the title (business or personal)

Year, Make, Model of Auto	Est. Market Value	Own or Lease	Over 6,000 lbs?	% Business	Name on Title?

CORPORATION/COMPANY DETAILS

CURRENT OWNERSHIP OF YOUR COMPANY:

Enter the names of your current shareholder/member(s) with their percentage (%) ownership

Owner Name	Ownership %

TITLES/POSITIONS IN YOUR COMPANY:

Please assign all current assigned or elected titles

Type of Organization:

Corporation

Limited Liabilities Company

Corporations Only
Assigned Title Corporation Officers (title per title)

President

Secretary

Treasurer

Corporation Directors - Can have multiple people here

Director's Name

LLCs Only
Assigned Title LLC Officers - Only one name One name per

Chief Manager

Secretary

Treasurer

LLC Directors - Can have multiple people here

Governor's Name

OFFICERS VS DIRECTORS: Generally, officers of a corporation run the day-to-day operations of a corporation. Directors serve in an advisory role and help in the strategic planning of the corporation by Florida officers may need to be licensed as well.

CONTACT INFORMATION FOR OWNERS/OFFICERS

#1 Owner/Officer:

This will be the company PRIMARY CONTACT and signer for tax returns.

NOTE: The primary contact’s email address and mailing address will be used for all FMA, C.P.A. correspondence and sensitive tax information.

First, MI, Last

DOB

SS#

Address

Street Address

City

State

Zip Code

Best Phone

Email

#2 Owner/Officer:

This will be an additional contact for the company and should not be the primary contact.

First, MI, Last

DOB

SS#

Address

Street Address

City

State

Zip Code

Best Phone

Email

Company Intake Form

USE OF YOUR INFORMATION:

COMPANY INFORMATION:

BUSINESS REGISTERED ADDRESS:

BUSINESS TAX ID NUMBERS:

COMPANY PRIMARY CONTACT FOR FMA, C.P.A. INFORMATION:

COMANY EMAIL ADDRESSES:

COMPANY PHONE NUMBERS:

BUSINESS IN OTHER STATES:

SALES TAX:

Payroll:

EMPLOYEES OF YOUR BUSINESS:

Benefits Provided:

HEALTH INSURANCE PREMIUMS:

OTHER:

AUTOS USED FOR THE BUSINESS:

CORPORATION/COMPANY DETAILS

CURRENT OWNERSHIP OF YOUR COMPANY:

TITLES/POSITIONS IN YOUR COMPANY:

CONTACT INFORMATION FOR OWNERS/OFFICERS

#1 Owner/Officer:

#2 Owner/Officer: