Submit Client Information

Client Name(s) or Entity Name *
Address
City
State
Zip Code
Contact Person(s) *
Contact Email(s) *
Contact Phone Number(s) *
Business Type & Industry *
Type of Work Requested *
Electronic or Paper Copies? *
Electronic
Paper
Would you like access to our client portal so you can upload/download documents?
What email(s) would you like to use for access? *
How did you hear about us?
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Notes
In order to begin rendering services from Miller, McNeish & Breedlove we require you to sign an engagement letter, would you like to sign this in office, via electronic signature or sent to you via USPS with a return envelope?
Please provide the name(s) & email(s) of all parties who would need to sign (ex: owner of business, taxpayer & spouse), if same contacts are applicable as listed above please choose "Same as contact info"
Electronic Signature *
Name(s) For Electronic Signature *
Email(s) For Electronic Signature *

Miller McNeish & Breedlove, PLLC