FMA, CPA Individual Intake Form - CPA & Business Advisory Services

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

NOTE: The Primary Contact’s email address & mailing address will be used for all FMA correspondence and sensitive tax
information.

Client (First, MI, Last)

Date / Time

SS#

Spouse (First, MI, Last)

Date / Time

SS#

Home Address

State

Zip

Address

City

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 out.

PHONE NUMBERS: Please check the box to indicate your preferred contact number.

Business Phone

Main #

Home Phone

Main #

Cell Phone #1

Main # Belongs To

Cell Phone #2

Main # Belongs To

Other – Identify

Main # Belongs To

REFERRAL SOURCE: If you were referred to FMA, C.P.A. please let us know who referred you.

Referred By

INVESTMENT REAL ESTATE: Do you currently own any investment real estate or rental properties?

Yes

ESTATE PLAN: Do you have an Estate Plan?

Yes

Repeater Field

First, Middle, Last	Date of Birth	SS# & Relationship