Small Business Client Intake

🏢

Business Identity & Legal Structure

Legal entity information, registration details, and tax classification.

Basic Information

Legal Business Name (as filed with IRS / State) *

Trade Name / DBA (if different)

EIN

State of Incorporation

Date of Formation

State(s) of Operation

Business Phone

Business Email

Website

Business Address (Principal Place of Business)

Mailing Address (if different)

Business Fiscal Year End

Step 1 of 8

🔍

Industry & Business Description

Sector classification, operations overview, and workforce details.

Industry & Operations

Primary Industry / Sector

NAICS Code (if known)

Years in Business

Describe the Business — Products / Services & Primary Customers *

Workforce

Full-Time Employees (W-2)

Part-Time Employees

Independent Contractors (1099)

Step 2 of 8

👥

Ownership & Key Personnel

All owners, members, shareholders, and key management. Ownership % must total 100%.

Owners & Principals

Owner / Principal 1

Full Legal Name

Title / Role

Ownership %

Date of Birth

SSN / ITIN (optional)

Phone / Email

Home Address

Responsible for Day-to-Day Operations?

Yes No

Key Management & Officers (Non-Owners)

Full Name	Title	Department	Phone / Email
				✕

Step 3 of 8

📚

Accounting Methods & Systems

Financial record-keeping approach, software, and banking.

Software & Banking

Accounting Software

Payroll Provider / Software

POS System

Primary Business Bank

Payment Processors Used

Dedicated Business Bank Account?

Yes No

Accepts Credit Cards / Digital Payments?

Yes No

Step 4 of 8

📊

Financial Snapshot & Balance Sheet

Most recent year income statement, balance sheet, and business loan schedule.

Income Statement — Most Recent Year

Approximate figures are acceptable if exact numbers are unavailable.

Gross Annual Revenue

$

Cost of Goods Sold (COGS)

$

Gross Profit

$

Total Operating Expenses

$

Net Income / Net Profit

$

Owner Draw / Salary Taken

$

Total Business Assets

$

Total Business Liabilities

$

Business Net Worth / Equity

$

Monthly Payroll

$

Monthly Rent

$

Outstanding Loans

$

Prior Year Revenue

$

Revenue Trend

Business Assets & Liabilities Detail

Business Assets

Cash / Checking Account(s)

Accounts Receivable

Inventory (Current Value)

Equipment / Machinery

Vehicles (Business-Owned)

Real Estate / Property Owned

Intellectual Property / Goodwill

Business Liabilities

Accounts Payable

Accrued Liabilities

Payroll Liabilities

Sales Tax Payable

Short-Term Loans / Lines of Credit

SBA / Long-Term Business Loans

Owner / Shareholder Loans

Business Loans Detail

Lender	Loan Type	Balance ($)	Monthly Pmt	Rate %	Maturity	Collateral?
							✕

Step 5 of 8

📑

Tax History & IRS / State Correspondence

Filing compliance, back taxes, audits, and estimated tax payments.

Sales Tax & Estimated Payments

Required to Collect Sales Tax?

Yes No Unsure

Sales Tax Filing Frequency

Pays Estimated Quarterly Taxes?

Yes No

Annual Est. Tax Payments Made

Step 6 of 8

📄

Contracts, Leases & Insurance

Real estate leases, major agreements, litigation, and business insurance policies.

Real Estate Leases

Property / Location	Lease Type	Monthly Rent	Lease Start	Lease End	Landlord / Contact
						✕

Major Contracts & Legal Matters

Contract Type	Other Party / Vendor	Value ($)	Start Date	End / Renewal	Annual?
						✕

Currently Involved in Litigation?

Yes No

Pending Judgments or Liens Against the Business?

Yes No

Describe Any Legal Matters, Pending Lawsuits, or Judgments

Business Insurance Policies

Type of Insurance	Insurance Company	Policy Number	Coverage Amt ($)	Annual Premium ($)	Expiration
						✕

Step 7 of 8

🎯

Goals, Documents & Authorization

Top business concerns, required documents checklist, and authorization.

Top Business Concerns & Goals

Concern / Goal #1

Topic

Describe in Detail

Concern / Goal #2

Topic

Describe in Detail

Concern / Goal #3

Topic

Describe in Detail

Additional Notes & Special Circumstances

Required Documents Checklist

Permanent File — Legal & Formation Documents

Current Period — Financial & Tax Records

Contracts, Agreements & Other Documents

Document Notes

Authorization & Signatures

By signing below, I/we certify that the information provided in this business intake form is accurate and complete to the best of my/our knowledge. I/we authorize R.M. White CPA to use this information solely for the purpose of providing accounting, tax, and financial planning services. I/we understand this information will be held in strict confidence.

Authorized Signature — Owner / Officer

Printed Name & Title

Date

Signature (print, sign, or type above line)

Authorized Signature — Owner / Officer #2 (if applicable)

Printed Name & Title

Date

Signature (print, sign, or type above line)

Signature — Financial Planner / CPA

Printed Name — CPA / Planner

Date

CPA License / Credential Number

Engagement Type

CPA / Planner Signature

Step 8 of 8

Business Identity & Legal Structure

Industry & Business Description

Ownership & Key Personnel

Accounting Methods & Systems

Financial Snapshot & Balance Sheet

Tax History & IRS / State Correspondence

Contracts, Leases & Insurance

Goals, Documents & Authorization

Intake Submitted!