Intake Form Thank you for your interest in Clark and Cassidy. The first step to getting on our calendar is to thoughtfully complete the following questionnaire. It will help us determine if our two companies will be a good fit and how we can best serve your needs. Name* First Last Company Name*Email* PhoneAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Website How did you hear about Clark and Cassidy?About Your BusinessWe specialize in working with Entrepreneurs who are interested in cash flow management and maximizing their profitability. Are you interested in increasing your profit?*YesNoWhat industry most closely fits your business?*How long have you been in business?*What was your business revenue over the last twelve months?*Do you regularly pay yourself?YesNoWhat system do you currently use for your bookkeeping?*Is your bookkeeping up to date and current?*YesNoBriefly explain why and how far you are behindAre you current with all tax filings (i.e., payroll, sales tax, income tax, etc.)?*YesNoPlease indicate why and how many periods have not been filed or paidWhat is the #1 challenge you are dealing with today, that if we solved together, would create the biggest impact in your business?*On a scale of 1 – 10 (10 being highest), how urgently important is it for you to get started, and why?*1 No urgency2345678910 Extremely urgentCan you briefly tell us why?CAPTCHAEmailThis field is for validation purposes and should be left unchanged.