Bank Statement Questionnaire

GENERAL COMPANY INFORMATION

OPERATING DETAILS

FORM COMPLETED BY

Printed Name:

Are you an owner or company CPA?

If CPA, complete the following:

Company Name:

Physical Address:

Email Address: Phone:

Signature: Date:

Bank Account Type:If Personal, does a separate Business account exist?

Number of Employees (including 1099):

Does the business operate out of your home?

Owner CPA

Yes No

Business Personal

Yes No

If No, enter the total number of physical locations?

%

Note: Do not include owners in this number

(including 1099)

txtDescription: grpHomeBased: OfftxtPrintedName: grpCompletedBy: OfftxtCompanyCPA: txtEmailCPA: txtPhoneCPA: ddbStateCPA: [BLANK]txtZipCPA: dtClient: btnReset: grpAccountType: OffgrpBizAccount: OfftxtLocations: txtEmployees: lbl1: Company Name:txtCompanyName: txtWebsite: lbl2: Website Address:txtOwnership: lbl3: Percentage of Ownership:lbl12: Provide a detailed business description:txtStreetAddressCPA: Add Logo_af_image: