First Name *

Last Name *

EMAIL *

1. How did you hear about us? *

2. What are your main business concerns ultimate goals? *

3. How do you believe we can help? *

4. What is your filing status? *

5. What is your marginal tax rate? *

(What tax bracket do you fall in? Refer to the above chart, find your net income in the right column and then select your % in the box below, which will be to the left of that same row)

6. What forms do you file for your business? *

Please specify (if any other)

7. Does your spouse work in the business? *

Yes

No

8. Business Name *

9. What state do you file your individual state tax returns? *

10. In what state is your business operating? *

11. What is your percentage of ownership? *

12. What services you provide? *

13. Is this a specified service? *

Yes

No

14. How many employees do you have? *

15. How many business owners are there for this business? *

16. How many businesses do you own? *

17. How many years have you been in business? *

18. What is your business entity? *

Please specify (if other)

19. What is your current annual gross revenue? *

$

20. What is your current annual net revenue? *

$

21. What was your estimated amount paid in taxes this previous year? *

$

22. How much was your approx. salary for the previous tax year or expected for this year from your business? *

$

(If you do not pay yourself a salary enter 0)

23. What was your approx. previous year W2 income? *

$

24. What was your approx. taxable income? *

$

(If you worked for someone this would be W2- Enter 0 if no taxable income)

25. What is the approx. amount of income that is subject to self employment tax if any? *

$

(Enter 0 if no self employment tax)

26. What is the approx. amount of capital gains income if any? (Gains from Investments) *

$

(Enter 0 if no capital gains income)

27. Did you take the home office deduction last year? *

Yes

No

How much?

$

28. What is the approx. amount of qualified business property if any? *

$

(Any buildings/land - Enter 0 if none)

29. Did you deduct for meals on your previous tax returns? *

Yes

No

Previous year’s total tax return amount?

$

30. Do you have any children; Do you take care of parents that live with you? *

Yes

No

Please specify the total count:

31. Do you currently contribute to a retirement plan? *

Yes

No

Total annual contribution amount?

$

32. Are you open to having meetings in your home if it would provide you tax savings? *

Yes

No

Estimated cost per home meeting?

$

33. Do you do any research and development? *

Yes

No

34. Do you pay more than 50K for insurance per year? *

Yes

No

Annual Insurance Cost?

$

35. Do you own any buildings? *

Yes

No

Real Estate Market Value?

$

36. Do you offer benefits to your employees? *

Yes

No

37. Did you purchase a vehicle or any equipment this year that you use for your business? *

Yes

No

Vehicle approx. total cost?

$

38. Were there tips paid in your business? *

Yes

No

Overall Asset Cost?

$

39. Your Total Estimated Tax Savings *

40. Since last year, you paid the above amount in taxes. If this year looked similar, what portion of that would you ideally want working for you inside a Private Wealth Strategy? *

$

41. CPA Authorization Code *