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CPA Insurance
Accounting or Booking Service Insurance Package
Applicant's First Name
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Applicant's Last Name
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Email Address
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Phone Number
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What was your gross revenue for the past 12 months?
$0
$5,000
$10,000
$15,000
$20,000
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$40,000
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$1,400,000
$1,500,000
$1,600,000
$1,700,000
$1,800,000
$1,900,000
$2,000,000
$2,000,000+
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Over the past 12 months, was all your gross revenue from customers in Canada?
Yes
No
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Where was your gross revenue generated?
USA
Europe
Other
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What is your projected gross revenue over the next 12 months?
$0
$5,000
$10,000
$15,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
$80,000
$90,000
$100,000
$125,000
$150,000
$175,000
$200,000
$225,000
$250,000
$275,000
$300,000
$325,000
$350,000
$375,000
$400,000
$425,000
$450,000
$475,000
$500,000
$550,000
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$750,000
$800,000
$850,000
$900,000
$950,000
$1,000,000
$1,100,000
$1,200,000
$1,300,000
$1,400,000
$1,500,000
$1,600,000
$1,700,000
$1,800,000
$1,900,000
$2,000,000
$2,000,000+
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In the next 12 months, will all your projected gross revenue be from customers in Canada?
Yes
No
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Where will your projected gross revenue be generated?
USA
Europe
Other
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Select the following services you provide
Bookkeeping Services
Tax Return Preparation (Personal or Corporate)
Non-review Engagements
Review Engagements
Compilations
Investment Consulting
Management Advisory Services
Payroll Services
Other
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Please describe the additional services you provide
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Select all the services that you provide
Business Valuations
Audit Engagements
Mergers & Acquisitions Activity
Forecasts, Projections
Limited partnership or tax shelter syndication
Provide services to publicly traded companies
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Please provide the following information about your business
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
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Address
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Postal Code
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What best describes the ownership structure of your business?
Incorporated Company
Sole Proprietorship
Partnership
Non-Profit Organization
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What is the full legal name of your business?
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What are the full legal names of all parties in the partnership?
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What is the full legal name of the charity/non-profit/association?
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