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Intake Form
Audit and Assurance Service
This form is a request for an estimate of the potential assurance service fee. We will contact you in order to provide the estimated fee for our service.
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Contact Name*
Company Name (full legal name)*
Business Structure*
Description of the Company*
​Industry Classification*
Company Size*
Date of Incorporation*
State of Incorporation*
Company Address*
Company Website*
Email Address*
Phone Number*
Best Way to Contact*
Best Time to Call
Notes/Comments
Business Activity Information
Average Volume of Monthly Revenue Transactions*
Average Annual Revenue, USD*
Have Separate Business Bank Account?*
Company Payment Methods*
​Bookkeeping Type*
Quality of Records*
Accounting System*
​Accounting method*
Do You Have Business Assets? (computers,equipment tools, etc)*
Do You Have International Transactions/Activity?*
Do You Have a Written Policy?*
Type of Offering*
Other, Please Describe
Assets
Cash*
Investments*
Loans to Others or Owners*
Inventory*
Fixed Assets (equipment)*
Real Esatate/Buildings*
Goodwill/Patents/Other Intangible Assets*
Other Assets
Liability
Long Term Debts*
Short Term Debts*
Bonds*
Accounts Payable*
Deferred Revenue*
Other Liability
Equity
Capital Structure*
Current Year Capital Contribution*
If Other, Please, Describe
Other Equity
​Previously Audited/Reviewed*
Do You Have an Audit Report Available?*
Date of Report*
Service Request *
Other Services
Service Timeline *
Additional Notes
How did you hear about us?
Please upload attachments here, or Email to iwhitnah@whitnahcpa.com
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