Fill out online,
then print and mail application with dues of $125 to:
entrepreneurial CPA network 4718 N. 33rd Street
Phoenix, AZ 85018
602.468.0281
Membership Application Form
DATE:
NAME:
PHONE:
CPA FIRM NAME:
FAX:
STREET OR P.O. BOX
ADDRESS:
E-MAIL:
CITY:
WEBSITE:
STATE
&
ZIP
CODE:
STATE OF CPA
LICENSURE:
1. Are you a practicing
CPA? Yes No If
YES, continue to the next
question. If NO, go to
(4)
2. Do you have an ownership
interest in a CPA
practice? Yes
No
3. Please describe your practice
(for example: niches, how long had own CPA firm, other
accounting activities, etc.). You will describe this in more
detail in the following Practice Specialization Survey.
You qualify for full membership: please complete the
following Practice Specialization Survey sheet and print
and mail with your application and dues ($125) to eCPAn at
the above address..
4.. Are you employed in the
field of accounting. (either in a practice, as a student or
are you retired) Yes No
If YES, please describe.
entrepreneurial CPA network Practice Specialization
Survey
What accounting software are you using? MAS 90 / MAS
200
Microsoft Great Plains MYOB Oracle Small Business (Netledger) Peachtree QuickBooks Industry Specific
Software
Other
For Industry Specific software or Other, please describe.
What tax software are you using? ATX CCH Prosystems Creative Solutions Drake
Lacerte (Intuit)
ProSeries (Intuit)
Other
What accounting services do you provide? Monthly
Bookkeeping
Controller Services (describe below) Compilations Reviews Audits Set-up of computerized accounting
software
Other (describe below)
For Controller Services or Other, please describe.
What tax services do you provide?
Return Preparation
Consulting /
Planning
Description
Individual (1040)
C
Corporation (1120)
S
Corporation (1120S)
Partnership (1065)
Tax-exempt Organization (990)
Fiduciary (trust) (1041)
Estate (709)
Gift (706)
Pension
(5500)
What industries do you specialize with? Real Estate Construction
Manufacturing Retail Medical Legal Service / Professionals Government
Entertainment Hospitality Restaurant Wholesale Other
For Other, please describe.
What consulting services do you provide? Investments Business
Valuations
Insurance
Employee Benefits Other
Anything else you would like to say about your practice?