Lexington, KY CPA / Financial Concepts, Inc.
Client Portal  


Please complete the form below prior to your appointment with Financial Concepts, Inc.  Submission of this form constitues acknowledgement that you have read and agreed to our Fees and Payment Policy and our Terms and Conditions listed below.

New Individual Client Information

How did you find us?
Name *
Spouse
Address *
Address - Continued
City *
State *
Zip Code *
Home Phone Number
Cell Phone
Cell Phone - Spouse
Work Phone
Work Phone - Spouse
E-Mail *
E-Mail - Spouse
Occupation *
Occupation - Spouse
Date of Birth *
Date of Birth - Spouse
Dependent Name
Dependent Date of Birth
Dependent #2 Name
Dependent #2 Date of Birth
Dependent #3 Name
Dependent #3 Date of Birth
Tax Return Filing Status
Do you have a copy of last year's tax return? Yes No
Do you have childcare expenses? Yes No
Do you have a Will? Yes No
Do you have a Living Will? Yes No
Do you have a Power of Attorney? Yes No
Do you have Life Insurance? Yes No
If so, please choose one
Do you have College Savings Fund(s)? Yes No
Additional Dependents/ Dates of Birth and Other Information

FEES AND PAYMENTS

Our standard consulting fees are billed by the hour depending on the service provided.  We have a fee schedule for various services we provide.  Please feel free to ask for an approximate price quote.  Payments are required at the time of service.  Financial Concepts, Inc. accepts payment by cash, check, Visa, MasterCard or Discover.

TERMS AND CONDITIONS

The client attests to the fact that all information provided by Financial Concepts, inc. is fair and accurate with respect to the services requested and the client agrees to pay for all services provided.

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