Free Analysis Request

1. Please provide the following contact information:

   Name
   Title
   Organization
   Work Phone
   Address
   City
   State, Zip
   Fax
   e-mail

2. Briefly describe your operations:

3. Select any of the following options that apply (to select multiple answers hold down the Ctrl button on your keyboard):

I would like to know how much your services will cost. I prefer to complete the REQUEST during a personal conference. Please keep me in your active file.

4. What accounting services do you currently receive?

5. What additional accounting services would you like to receive?

   
   

6. What are your financial goals?

   
   

A. BUSINESS ENVIRONMENT

1. Annual sales volume:

   
   

2. Number of employees:

   
   

3. Form of ownership:

   Choose One Corporation Sole Proprietorship Partnership Other
   

4. How many shareholders/owners do you have?

   
   

5. How many shareholders/owners are involved in day to day operations?

   
   

6. Your management structure is:

   Formal
   Informal
   
   

7. Your building is owned by or leased from:

   Choose One Shareholder/owner Outside party
   

8. Hardware

   None
   Stand Alone PCs
   Networked PCs
   

9. Processor (to select multiple answers hold down the Ctrl button on your keyboard):

   386 486 586 Other

10. Operating system (to select multiple answers hold down the Ctrl button on your keyboard):

    DOS Windows 3.1 Windows 95 Windows 98 Windows NT Novell IBM OS/2 Other

B. ACCOUNTING

1. What basis of accounting do you use to keep your books?

   Choose One Cash Accrual
   

2. What is your fiscal year-end?

   Choose One January February March April May June July August September October November December
   

3. How automated is your accounting?

   Choose One Computerized One-Write Manual
   

4. Accounting software used

   
   

5. How many customer accounts do you have?

   Choose One 0-100 100-300 300-500 500-1,000 1,000+
   

6. Do you have trouble balancing each month?

   Choose One Usually Occasionally Rarely
   

7. Would you describe your accounting system as complicated?

   Very much Somewhat Not complicated
   

8. Are you behind in your bookkeeping?

   Choose One Yes No
   

9. Does your accounting system meet all of your needs?

   Choose One Usually Sometimes Rarely
   

10. Do you have adequate internal controls?

    Choose Yes/No Yes No
    

11. Do you require an annual audit in accordance with standards established by the American Institute of Certified Public Accountants?

    Choose Yes/No Yes No
    

12. Describe your accounting challenges and shortfalls:

    
    

C. TAXES

1. Are you an S Corporation?

   Choose Yes/No Yes No
   

2. Are you providing for your retirement (to select multiple answers hold down the Ctrl button on your keyboard)?

   Profit sharing/pension plan 401k IRA/SEP Other

3. Do you feel you have opportunity to reduce your taxes?

   Choose Yes/No Yes No
   

4. If yes, please describe

   
   

5. Do you require taxpayer representation?

   Choose Yes/No Yes No
   

6. Describe any tax problems you have:

   
   

D. CONSULTING

1. I need consulting regarding the following (to select multiple answers hold down the Ctrl button on your keyboard):

   Loan negotiations Expert witness Business valuation DBA Acctg/Mfg/Dist Software Custom computer application Decision & risk analysis Other