<form class="jotform-form" action="https://submit.jotform.com/submit/221468344475158/" method="post" name="form_221468344475158" id="221468344475158" accept-charset="utf-8" autocomplete="on">
<input type="hidden" name="formID" value="221468344475158" />
<input type="hidden" id="JWTContainer" value="" />
<input type="hidden" id="cardinalOrderNumber" value="" />
<div role="main" class="form-all">
<style>
.form-all:before { background: none;}
</style>
<ul class="form-section page-section">
<li id="cid_1" class="form-input-wide" data-type="control_head">
<div class="form-header-group header-large">
<div class="header-text httac htvam">
<h1 id="header_1" class="form-header" data-component="header">
Bookkeeping Client Intake Form
</h1>
</div>
</div>
</li>
<li class="form-line" data-type="control_fullname" id="id_12">
<label class="form-label form-label-top form-label-auto" id="label_12" for="first_12"> Name </label>
<div id="cid_12" class="form-input-wide" data-layout="full">
<div data-wrapper-react="true">
<span class="form-sub-label-container" style="vertical-align:top" data-input-type="first">
<input type="text" id="first_12" name="q12_name[first]" class="form-textbox" data-defaultvalue="" autoComplete="section-input_12 given-name" size="10" value="" data-component="first" aria-labelledby="label_12 sublabel_12_first" />
<label class="form-sub-label" for="first_12" id="sublabel_12_first" style="min-height:13px" aria-hidden="false"> First Name </label>
</span>
<span class="form-sub-label-container" style="vertical-align:top" data-input-type="last">
<input type="text" id="last_12" name="q12_name[last]" class="form-textbox" data-defaultvalue="" autoComplete="section-input_12 family-name" size="15" value="" data-component="last" aria-labelledby="label_12 sublabel_12_last" />
<label class="form-sub-label" for="last_12" id="sublabel_12_last" style="min-height:13px" aria-hidden="false"> Last Name </label>
</span>
</div>
</div>
</li>
<li class="form-line form-line-column form-col-1" data-type="control_email" id="id_13">
<label class="form-label form-label-top" id="label_13" for="input_13"> Email </label>
<div id="cid_13" class="form-input-wide" data-layout="half">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="email" id="input_13" name="q13_email" class="form-textbox validate[Email]" data-defaultvalue="" style="width:310px" size="310" value="" data-component="email" aria-labelledby="label_13 sublabel_input_13" />
<label class="form-sub-label" for="input_13" id="sublabel_input_13" style="min-height:13px" aria-hidden="false"> [email protected] </label>
</span>
</div>
</li>
<li class="form-line form-line-column form-col-2" data-type="control_phone" id="id_14">
<label class="form-label form-label-top" id="label_14" for="input_14_full"> Phone Number </label>
<div id="cid_14" class="form-input-wide" data-layout="half">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="tel" id="input_14_full" name="q14_phoneNumber[full]" data-type="mask-number" class="mask-phone-number form-textbox validate[Fill Mask]" data-defaultvalue="" autoComplete="section-input_14 tel-national" style="width:310px" data-masked="true" value="" placeholder="(000) 000-0000" data-component="phone" aria-labelledby="label_14 sublabel_14_masked" />
<label class="form-sub-label" for="input_14_full" id="sublabel_14_masked" style="min-height:13px" aria-hidden="false"> Please enter a valid phone number. </label>
</span>
</div>
</li>
<li class="form-line" data-type="control_radio" id="id_15">
<label class="form-label form-label-top" id="label_15" for="input_15"> Please choose which one do you want to be contacted by </label>
<div id="cid_15" class="form-input-wide" data-layout="full">
<div class="form-multiple-column" data-columncount="2" role="group" aria-labelledby="label_15" data-component="radio">
<span class="form-radio-item">
<span class="dragger-item">
</span>
<input type="radio" aria-describedby="label_15" class="form-radio" id="input_15_0" name="q15_pleaseChoose15" value="Phone" />
<label id="label_input_15_0" for="input_15_0"> Phone </label>
</span>
<span class="form-radio-item">
<span class="dragger-item">
</span>
<input type="radio" aria-describedby="label_15" class="form-radio" id="input_15_1" name="q15_pleaseChoose15" value="Email" />
<label id="label_input_15_1" for="input_15_1"> Email </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" aria-describedby="label_15" class="form-radio" id="input_15_2" name="q15_pleaseChoose15" value="Does not matter" />
<label id="label_input_15_2" for="input_15_2"> Does not matter </label>
</span>
<span class="form-radio-item formRadioOther">
<input type="radio" class="form-radio-other form-radio" name="q15_pleaseChoose15" id="other_15" value="other" tabindex="0" aria-label="Other" />
<label id="label_other_15" style="text-indent:0" for="other_15"> Other </label>
<span id="other_15_input" class="other-input-container" style="display:none">
<input type="text" class="form-radio-other-input form-textbox" name="q15_pleaseChoose15[other]" data-otherhint="Other" size="15" id="input_15" data-placeholder="Please type another option here" placeholder="Please type another option here" />
</span>
</span>
</div>
</div>
</li>
<ul class="form-section" id="section_47">
<li id="cid_47" class="form-input-wide" data-type="control_collapse">
<div class="form-collapse-table" id="collapse_47" data-component="collapse">
<span class="form-collapse-mid" id="collapse-text_47">
Company Information
</span>
<span class="form-collapse-right form-collapse-right-show">
</span>
</div>
</li>
<li class="form-line form-line-column form-col-1" data-type="control_textbox" id="id_16">
<label class="form-label form-label-top" id="label_16" for="input_16"> Company Name </label>
<div id="cid_16" class="form-input-wide" data-layout="half">
<input type="text" id="input_16" name="q16_companyName" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" value="" data-component="textbox" aria-labelledby="label_16" />
</div>
</li>
<li class="form-line form-line-column form-col-2" data-type="control_textbox" id="id_18">
<label class="form-label form-label-top" id="label_18" for="input_18"> Company Website </label>
<div id="cid_18" class="form-input-wide" data-layout="half">
<input type="text" id="input_18" name="q18_companyWebsite" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" value="" data-component="textbox" aria-labelledby="label_18" />
</div>
</li>
<li class="form-line" data-type="control_address" id="id_17">
<label class="form-label form-label-top form-label-auto" id="label_17" for="input_17_addr_line1"> Company Address </label>
<div id="cid_17" class="form-input-wide" data-layout="full">
<div summary="" class="form-address-table jsTest-addressField">
<div class="form-address-line-wrapper jsTest-address-line-wrapperField">
<span class="form-address-line form-address-street-line jsTest-address-lineField">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" id="input_17_addr_line1" name="q17_companyAddress[addr_line1]" class="form-textbox form-address-line" data-defaultvalue="" autoComplete="section-input_17 address-line1" value="" data-component="address_line_1" aria-labelledby="label_17 sublabel_17_addr_line1" required="" />
<label class="form-sub-label" for="input_17_addr_line1" id="sublabel_17_addr_line1" style="min-height:13px" aria-hidden="false"> Street Address </label>
</span>
</span>
</div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField">
<span class="form-address-line form-address-street-line jsTest-address-lineField">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" id="input_17_addr_line2" name="q17_companyAddress[addr_line2]" class="form-textbox form-address-line" data-defaultvalue="" autoComplete="section-input_17 address-line2" value="" data-component="address_line_2" aria-labelledby="label_17 sublabel_17_addr_line2" />
<label class="form-sub-label" for="input_17_addr_line2" id="sublabel_17_addr_line2" style="min-height:13px" aria-hidden="false"> Street Address Line 2 </label>
</span>
</span>
</div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField">
<span class="form-address-line form-address-city-line jsTest-address-lineField ">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" id="input_17_city" name="q17_companyAddress[city]" class="form-textbox form-address-city" data-defaultvalue="" autoComplete="section-input_17 address-level2" value="" data-component="city" aria-labelledby="label_17 sublabel_17_city" required="" />
<label class="form-sub-label" for="input_17_city" id="sublabel_17_city" style="min-height:13px" aria-hidden="false"> City </label>
</span>
</span>
<span class="form-address-line form-address-state-line jsTest-address-lineField ">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" id="input_17_state" name="q17_companyAddress[state]" class="form-textbox form-address-state" data-defaultvalue="" autoComplete="section-input_17 address-level1" value="" data-component="state" aria-labelledby="label_17 sublabel_17_state" required="" />
<label class="form-sub-label" for="input_17_state" id="sublabel_17_state" style="min-height:13px" aria-hidden="false"> State / Province </label>
</span>
</span>
</div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField">
<span class="form-address-line form-address-zip-line jsTest-address-lineField ">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" id="input_17_postal" name="q17_companyAddress[postal]" class="form-textbox form-address-postal" data-defaultvalue="" autoComplete="section-input_17 postal-code" value="" data-component="zip" aria-labelledby="label_17 sublabel_17_postal" required="" />
<label class="form-sub-label" for="input_17_postal" id="sublabel_17_postal" style="min-height:13px" aria-hidden="false"> Postal / Zip Code </label>
</span>
</span>
</div>
</div>
</div>
</li>
<li class="form-line" data-type="control_textarea" id="id_19">
<label class="form-label form-label-top form-label-auto" id="label_19" for="input_19"> Please briefly explain what your company does </label>
<div id="cid_19" class="form-input-wide" data-layout="full">
<textarea id="input_19" class="form-textarea" name="q19_pleaseBriefly19" style="width:648px;height:163px" data-component="textarea" aria-labelledby="label_19"></textarea>
</div>
</li>
<li class="form-line form-line-column form-col-1" data-type="control_datetime" id="id_43">
<label class="form-label form-label-top" id="label_43" for="lite_mode_43"> Starting date of your company </label>
<div id="cid_43" class="form-input-wide" data-layout="half">
<div data-wrapper-react="true">
<div style="display:none">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="tel" class="form-textbox validate[limitDate]" id="month_43" name="q43_startingDate43[month]" size="2" data-maxlength="2" data-age="" maxLength="2" value="" autoComplete="section-input_43 off" aria-labelledby="label_43 sublabel_43_month" />
<span class="date-separate" aria-hidden="true">
-
</span>
<label class="form-sub-label" for="month_43" id="sublabel_43_month" style="min-height:13px" aria-hidden="false"> Month </label>
</span>
<span class="form-sub-label-container" style="vertical-align:top">
<input type="tel" class="form-textbox validate[limitDate]" id="day_43" name="q43_startingDate43[day]" size="2" data-maxlength="2" data-age="" maxLength="2" value="" autoComplete="section-input_43 off" aria-labelledby="label_43 sublabel_43_day" />
<span class="date-separate" aria-hidden="true">
-
</span>
<label class="form-sub-label" for="day_43" id="sublabel_43_day" style="min-height:13px" aria-hidden="false"> Day </label>
</span>
<span class="form-sub-label-container" style="vertical-align:top">
<input type="tel" class="form-textbox validate[limitDate]" id="year_43" name="q43_startingDate43[year]" size="4" data-maxlength="4" data-age="" maxLength="4" value="" autoComplete="section-input_43 off" aria-labelledby="label_43 sublabel_43_year" />
<label class="form-sub-label" for="year_43" id="sublabel_43_year" style="min-height:13px" aria-hidden="false"> Year </label>
</span>
</div>
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" class="form-textbox validate[limitDate, validateLiteDate]" id="lite_mode_43" size="12" data-maxlength="12" maxLength="12" data-age="" value="" data-format="mmddyyyy" data-seperator="-" placeholder="MM-DD-YYYY" autoComplete="section-input_43 off" aria-labelledby="label_43 sublabel_43_litemode" />
<img class=" newDefaultTheme-dateIcon icon-liteMode" alt="Pick a Date" id="input_43_pick" src="https://cdn.jotfor.ms/images/calendar.png" data-component="datetime" aria-hidden="true" data-allow-time="No" data-version="v2" />
<label class="form-sub-label" for="lite_mode_43" id="sublabel_43_litemode" style="min-height:13px" aria-hidden="false"> Date </label>
</span>
</div>
</div>
</li>
<li class="form-line form-line-column form-col-2" data-type="control_textbox" id="id_42">
<label class="form-label form-label-top" id="label_42" for="input_42"> Your job title </label>
<div id="cid_42" class="form-input-wide" data-layout="half">
<input type="text" id="input_42" name="q42_yourJob" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" value="" data-component="textbox" aria-labelledby="label_42" />
</div>
</li>
<li class="form-line form-line-column form-col-3" data-type="control_textbox" id="id_22">
<label class="form-label form-label-top" id="label_22" for="input_22"> Number of employees including you </label>
<div id="cid_22" class="form-input-wide" data-layout="half">
<input type="text" id="input_22" name="q22_numberOf" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" value="" data-component="textbox" aria-labelledby="label_22" />
</div>
</li>
<li class="form-line form-line-column form-col-4" data-type="control_textbox" id="id_23">
<label class="form-label form-label-top" id="label_23" for="input_23"> Type of your company </label>
<div id="cid_23" class="form-input-wide" data-layout="half">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" id="input_23" name="q23_typeOf" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" value="" data-component="textbox" aria-labelledby="label_23 sublabel_input_23" />
<label class="form-sub-label" for="input_23" id="sublabel_input_23" style="min-height:13px" aria-hidden="false"> LLC, S-Corp, C-Corp, Sole-Proprietor </label>
</span>
</div>
</li>
<li class="form-line" data-type="control_radio" id="id_24">
<label class="form-label form-label-top form-label-auto" id="label_24" for="input_24"> File federal taxes </label>
<div id="cid_24" class="form-input-wide" data-layout="full">
<div class="form-multiple-column" data-columncount="2" role="group" aria-labelledby="label_24" data-component="radio">
<span class="form-radio-item">
<span class="dragger-item">
</span>
<input type="radio" aria-describedby="label_24" class="form-radio" id="input_24_0" name="q24_fileFederal24" value="On a cash basis" />
<label id="label_input_24_0" for="input_24_0"> On a cash basis </label>
</span>
<span class="form-radio-item">
<span class="dragger-item">
</span>
<input type="radio" aria-describedby="label_24" class="form-radio" id="input_24_1" name="q24_fileFederal24" value="Accural" />
<label id="label_input_24_1" for="input_24_1"> Accural </label>
</span>
</div>
</div>
</li>
<li class="form-line form-line-column form-col-1" data-type="control_textbox" id="id_25">
<label class="form-label form-label-top" id="label_25" for="input_25"> Your CPA and the firm they are with </label>
<div id="cid_25" class="form-input-wide" data-layout="half">
<input type="text" id="input_25" name="q25_yourCpa25" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" value="" data-component="textbox" aria-labelledby="label_25" />
</div>
</li>
<li class="form-line" data-type="control_textbox" id="id_26">
<label class="form-label form-label-top" id="label_26" for="input_26"> What bank is your main business account with? </label>
<div id="cid_26" class="form-input-wide" data-layout="half">
<input type="text" id="input_26" name="q26_whatBank" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" value="" data-component="textbox" aria-labelledby="label_26" />
</div>
</li>
</ul>
<ul class="form-section" id="section_27">
<li id="cid_27" class="form-input-wide" data-type="control_collapse">
<div class="form-collapse-table" id="collapse_27" data-component="collapse">
<span class="form-collapse-mid" id="collapse-text_27">
Accounting Information and Needs
</span>
<span class="form-collapse-right form-collapse-right-show">
</span>
</div>
</li>
<li class="form-line form-line-column form-col-1" data-type="control_textbox" id="id_28">
<label class="form-label form-label-top" id="label_28" for="input_28"> Accounting software you use </label>
<div id="cid_28" class="form-input-wide" data-layout="half">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" id="input_28" name="q28_accountingSoftware" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" value="" data-component="textbox" aria-labelledby="label_28 sublabel_input_28" />
<label class="form-sub-label" for="input_28" id="sublabel_input_28" style="min-height:13px" aria-hidden="false"> If QuickBooks, please indicate Desktop or Online </label>
</span>
</div>
</li>
<li class="form-line form-line-column form-col-2" data-type="control_textbox" id="id_29">
<label class="form-label form-label-top" id="label_29" for="input_29"> Payroll software or company </label>
<div id="cid_29" class="form-input-wide" data-layout="half">
<input type="text" id="input_29" name="q29_payrollSoftware" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" value="" data-component="textbox" aria-labelledby="label_29" />
</div>
</li>
<li class="form-line" data-type="control_textbox" id="id_30">
<label class="form-label form-label-top form-label-auto" id="label_30" for="input_30"> Number of check/debit transactions you have each month </label>
<div id="cid_30" class="form-input-wide" data-layout="half">
<input type="text" id="input_30" name="q30_numberOf30" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" value="" data-component="textbox" aria-labelledby="label_30" />
</div>
</li>
<li class="form-line" data-type="control_checkbox" id="id_32">
<label class="form-label form-label-top" id="label_32" for="input_32"> Which ones do you enter? </label>
<div id="cid_32" class="form-input-wide" data-layout="full">
<div class="form-multiple-column" data-columncount="2" role="group" aria-labelledby="label_32" data-component="checkbox">
<span class="form-checkbox-item">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_32" class="form-checkbox" id="input_32_0" name="q32_whichOnes32[]" value="Bills" />
<label id="label_input_32_0" for="input_32_0"> Bills </label>
</span>
<span class="form-checkbox-item">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_32" class="form-checkbox" id="input_32_1" name="q32_whichOnes32[]" value="Payments" />
<label id="label_input_32_1" for="input_32_1"> Payments </label>
</span>
<span class="form-checkbox-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_32" class="form-checkbox" id="input_32_2" name="q32_whichOnes32[]" value="Checks" />
<label id="label_input_32_2" for="input_32_2"> Checks </label>
</span>
<span class="form-checkbox-item formCheckboxOther">
<input type="checkbox" class="form-checkbox-other form-checkbox" name="q32_whichOnes32[other]" id="other_32" value="other" tabindex="0" aria-label="Other" />
<label id="label_other_32" style="text-indent:0" for="other_32"> Other </label>
<span id="other_32_input" class="other-input-container" style="display:none">
<input type="text" class="form-checkbox-other-input form-textbox" name="q32_whichOnes32[other]" data-otherhint="Other" size="15" id="input_32" data-placeholder="Please type another option here" placeholder="Please type another option here" />
</span>
</span>
</div>
</div>
</li>
<li class="form-line" data-type="control_radio" id="id_33">
<label class="form-label form-label-top form-label-auto" id="label_33" for="input_33"> Do you pay 1099 vendors? </label>
<div id="cid_33" class="form-input-wide" data-layout="full">
<div class="form-multiple-column" data-columncount="2" role="group" aria-labelledby="label_33" data-component="radio">
<span class="form-radio-item">
<span class="dragger-item">
</span>
<input type="radio" aria-describedby="label_33" class="form-radio" id="input_33_0" name="q33_doYou33" value="Yes" />
<label id="label_input_33_0" for="input_33_0"> Yes </label>
</span>
<span class="form-radio-item">
<span class="dragger-item">
</span>
<input type="radio" aria-describedby="label_33" class="form-radio" id="input_33_1" name="q33_doYou33" value="No" />
<label id="label_input_33_1" for="input_33_1"> No </label>
</span>
</div>
</div>
</li>
<li class="form-line" data-type="control_textbox" id="id_34">
<label class="form-label form-label-top form-label-auto" id="label_34" for="input_34"> Approximately, how many invoices do you generate each month? </label>
<div id="cid_34" class="form-input-wide" data-layout="half">
<input type="text" id="input_34" name="q34_approximatelyHow34" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" value="" data-component="textbox" aria-labelledby="label_34" />
</div>
</li>
<li class="form-line" data-type="control_checkbox" id="id_36">
<label class="form-label form-label-top form-label-auto" id="label_36" for="input_36"> Please select the ones that appropriate to you </label>
<div id="cid_36" class="form-input-wide" data-layout="full">
<div class="form-multiple-column" data-columncount="2" role="group" aria-labelledby="label_36" data-component="checkbox">
<span class="form-checkbox-item">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_36" class="form-checkbox" id="input_36_0" name="q36_pleaseSelect36[]" value="Accepting credit cards" />
<label id="label_input_36_0" for="input_36_0"> Accepting credit cards </label>
</span>
<span class="form-checkbox-item">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_36" class="form-checkbox" id="input_36_1" name="q36_pleaseSelect36[]" value="Collecting sales tax" />
<label id="label_input_36_1" for="input_36_1"> Collecting sales tax </label>
</span>
<span class="form-checkbox-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_36" class="form-checkbox" id="input_36_2" name="q36_pleaseSelect36[]" value="Tracking inventory in Quickbooks or other software" />
<label id="label_input_36_2" for="input_36_2"> Tracking inventory in Quickbooks or other software </label>
</span>
<span class="form-checkbox-item formCheckboxOther">
<input type="checkbox" class="form-checkbox-other form-checkbox" name="q36_pleaseSelect36[other]" id="other_36" value="other" tabindex="0" aria-label="Other" />
<label id="label_other_36" style="text-indent:0" for="other_36"> Other </label>
<span id="other_36_input" class="other-input-container" style="display:none">
<input type="text" class="form-checkbox-other-input form-textbox" name="q36_pleaseSelect36[other]" data-otherhint="Other" size="15" id="input_36" data-placeholder="Please type another option here" placeholder="Please type another option here" />
</span>
</span>
</div>
</div>
</li>
<li class="form-line form-line-column form-col-1" data-type="control_textbox" id="id_37">
<label class="form-label form-label-top" id="label_37" for="input_37"> Number of bank accounts you have </label>
<div id="cid_37" class="form-input-wide" data-layout="half">
<input type="text" id="input_37" name="q37_numberOf37" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" value="" data-component="textbox" aria-labelledby="label_37" />
</div>
</li>
<li class="form-line form-line-column form-col-2" data-type="control_textbox" id="id_38">
<label class="form-label form-label-top" id="label_38" for="input_38"> Number of credit cards you have </label>
<div id="cid_38" class="form-input-wide" data-layout="half">
<input type="text" id="input_38" name="q38_numberOf38" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:310px" size="310" value="" data-component="textbox" aria-labelledby="label_38" />
</div>
</li>
<li class="form-line" data-type="control_radio" id="id_39">
<label class="form-label form-label-top form-label-auto" id="label_39" for="input_39"> Do you have any experience to work with a bookkeeping service before? </label>
<div id="cid_39" class="form-input-wide" data-layout="full">
<div class="form-multiple-column" data-columncount="2" role="group" aria-labelledby="label_39" data-component="radio">
<span class="form-radio-item">
<span class="dragger-item">
</span>
<input type="radio" aria-describedby="label_39" class="form-radio" id="input_39_0" name="q39_doYou39" value="Yes" />
<label id="label_input_39_0" for="input_39_0"> Yes </label>
</span>
<span class="form-radio-item">
<span class="dragger-item">
</span>
<input type="radio" aria-describedby="label_39" class="form-radio" id="input_39_1" name="q39_doYou39" value="No" />
<label id="label_input_39_1" for="input_39_1"> No </label>
</span>
</div>
</div>
</li>
<li class="form-line" data-type="control_checkbox" id="id_40">
<label class="form-label form-label-top form-label-auto" id="label_40" for="input_40"> Please select the services you want us to provide </label>
<div id="cid_40" class="form-input-wide" data-layout="full">
<div class="form-multiple-column" data-columncount="4" role="group" aria-labelledby="label_40" data-component="checkbox">
<span class="form-checkbox-item">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_40" class="form-checkbox" id="input_40_0" name="q40_pleaseSelect40[]" value="Client Billing" />
<label id="label_input_40_0" for="input_40_0"> Client Billing </label>
</span>
<span class="form-checkbox-item">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_40" class="form-checkbox" id="input_40_1" name="q40_pleaseSelect40[]" value="Financial Statements" />
<label id="label_input_40_1" for="input_40_1"> Financial Statements </label>
</span>
<span class="form-checkbox-item">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_40" class="form-checkbox" id="input_40_2" name="q40_pleaseSelect40[]" value="Year End Tax Package" />
<label id="label_input_40_2" for="input_40_2"> Year End Tax Package </label>
</span>
<span class="form-checkbox-item">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_40" class="form-checkbox" id="input_40_3" name="q40_pleaseSelect40[]" value="State Tax Reporting" />
<label id="label_input_40_3" for="input_40_3"> State Tax Reporting </label>
</span>
<span class="form-checkbox-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_40" class="form-checkbox" id="input_40_4" name="q40_pleaseSelect40[]" value="Business Start-Up Assistance" />
<label id="label_input_40_4" for="input_40_4"> Business Start-Up Assistance </label>
</span>
<span class="form-checkbox-item">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_40" class="form-checkbox" id="input_40_5" name="q40_pleaseSelect40[]" value="Monthly Account Reconciliation" />
<label id="label_input_40_5" for="input_40_5"> Monthly Account Reconciliation </label>
</span>
<span class="form-checkbox-item">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_40" class="form-checkbox" id="input_40_6" name="q40_pleaseSelect40[]" value="Budgeting/Forecasting" />
<label id="label_input_40_6" for="input_40_6"> Budgeting/Forecasting </label>
</span>
<span class="form-checkbox-item">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_40" class="form-checkbox" id="input_40_7" name="q40_pleaseSelect40[]" value="Transaction Entry" />
<label id="label_input_40_7" for="input_40_7"> Transaction Entry </label>
</span>
<span class="form-checkbox-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_40" class="form-checkbox" id="input_40_8" name="q40_pleaseSelect40[]" value="Payroll" />
<label id="label_input_40_8" for="input_40_8"> Payroll </label>
</span>
<span class="form-checkbox-item">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_40" class="form-checkbox" id="input_40_9" name="q40_pleaseSelect40[]" value="Business Consulting" />
<label id="label_input_40_9" for="input_40_9"> Business Consulting </label>
</span>
<span class="form-checkbox-item">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_40" class="form-checkbox" id="input_40_10" name="q40_pleaseSelect40[]" value="Contract Management" />
<label id="label_input_40_10" for="input_40_10"> Contract Management </label>
</span>
<span class="form-checkbox-item">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_40" class="form-checkbox" id="input_40_11" name="q40_pleaseSelect40[]" value="Cash Flow Reporting" />
<label id="label_input_40_11" for="input_40_11"> Cash Flow Reporting </label>
</span>
<span class="form-checkbox-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_40" class="form-checkbox" id="input_40_12" name="q40_pleaseSelect40[]" value="Bill Pay" />
<label id="label_input_40_12" for="input_40_12"> Bill Pay </label>
</span>
<span class="form-checkbox-item">
<span class="dragger-item">
</span>
<input type="checkbox" aria-describedby="label_40" class="form-checkbox" id="input_40_13" name="q40_pleaseSelect40[]" value="City Tax Reporting" />
<label id="label_input_40_13" for="input_40_13"> City Tax Reporting </label>
</span>
<span class="form-checkbox-item formCheckboxOther">
<input type="checkbox" class="form-checkbox-other form-checkbox" name="q40_pleaseSelect40[other]" id="other_40" value="other" tabindex="0" aria-label="Other" />
<label id="label_other_40" style="text-indent:0" for="other_40"> Other </label>
<span id="other_40_input" class="other-input-container" style="display:none">
<input type="text" class="form-checkbox-other-input form-textbox" name="q40_pleaseSelect40[other]" data-otherhint="Other" size="15" id="input_40" data-placeholder="Please type another option here" placeholder="Please type another option here" />
</span>
</span>
</div>
</div>
</li>
<li class="form-line" data-type="control_textarea" id="id_41">
<label class="form-label form-label-top form-label-auto" id="label_41" for="input_41"> Please give details about to service(s) you want from us </label>
<div id="cid_41" class="form-input-wide" data-layout="full">
<textarea id="input_41" class="form-textarea" name="q41_pleaseGive" style="width:648px;height:163px" data-component="textarea" aria-labelledby="label_41"></textarea>
</div>
</li>
<li class="form-line" data-type="control_textarea" id="id_44">
<label class="form-label form-label-top form-label-auto" id="label_44" for="input_44"> Additional information we should know </label>
<div id="cid_44" class="form-input-wide" data-layout="full">
<textarea id="input_44" class="form-textarea" name="q44_additionalInformation44" style="width:648px;height:163px" data-component="textarea" aria-labelledby="label_44"></textarea>
</div>
</li>
<li class="form-line jf-required" data-type="control_captcha" id="id_46">
<label class="form-label form-label-top form-label-auto" id="label_46" for="input_46">
Please verify that you are human
<span class="form-required">
*
</span>
</label>
<div id="cid_46" class="form-input-wide jf-required" data-layout="full">
<section data-wrapper-react="true">
<div id="recaptcha_input_46" data-component="recaptcha" data-callback="recaptchaCallbackinput_46" data-expired-callback="recaptchaExpiredCallbackinput_46">
</div>
<input type="hidden" id="input_46" class="hidden validate[required]" name="recaptcha_visible" required="" />
