Audit/Review Intake Form - Formstack

CrowdfundCPA Audit/Review Intake Form

Company Name (full legal name)*

Contact Name and Title*

Email*

Phone

Company Website

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

State of Incorporation*

State of Company Headquarters*

Date of Incorporation*

Company Type*

Description of the Company*

Are you seeking an audit or review?*

Reviews required for Reg CF over $100k (if first Reg CF offering), Audits required for all Reg A offerings (Tier II and generally for Tier I dependent upon states)

What other type of service are you looking for?

Type of offering?*

Crowdfunding Portal

Accounting System*

Please provide "accountant access" for your online accounting system to craig@artesiancpa.com

Please upload your Quickbooks "Accountant Transfer File"

No File Chosen

File uploads may not work on some mobile devices.

Alternatively, please upload the trial balance for the opening date of the applicable financial statements and each balance sheet date, and general ledgers for each such period, AP aging for each such date, AR aging for each such date.

Please upload your trial balance for the opening date of the applicable financial statements and each balance sheet date, and general ledgers for each such period, AP aging for each such date, AR aging for each such date.

No File Chosen

File uploads may not work on some mobile devices.

Please upload accounting records file(s)

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File uploads may not work on some mobile devices.

Please upload bank statements

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File uploads may not work on some mobile devices.

Are the accounting records maintained on the accrual basis (i.e. expenses recorded when incurred, rather than paid, revenues recognized when earned rather than paid, fixed assets capitalized and depreciated over useful life, etc.)*

Please upload your cap table, if available

No File Chosen

File uploads may not work on some mobile devices.

Stock Issuances: Describe the approximate amounts, timing of stock issuances, and any other key terms

i.e. Founders contributed initial working capital at formation in 2011, venture backed seed round in 2012 for ~$5M, Series A in 2014 for ~$10M, etc.

Equity for Services/Agreements/etc.: Please provide a description of these transactions (i.e. issued 10,000 shares for legal services worth $10,000, issued 5,000 shares in conjunction with a patent licensing agreement, etc.)*

Stock Options: Please thorough description of the stock options (approx # issued, who issued to (i.e. employees, directors, contractors), and who tracks/maintains the list (i.e. internal, legal, software)

Stock Options: Check all that apply

409a valuation completed? Formally adopted stock plan? Stock compensation expense is calculated and recorded? Vesting schedules maintained? GAAP footnote calculations maintained (i.e. weighted avg duration to expiration, weighted average exercise price, etc)? Black-Scholes calculations completed and support researched and maintained for all inputs?

Stock Warrants: Please describe if the nature of these, if they were affiliated with other financing (i.e. attached to or associated with debt or stock issuance), approx number issued, was Black-Scholes fair value calculated/recorded?

Convertible Debt: Please describe the nature and extent of convertible note issuances (i.e. how many notes, when issued, relative dollar amount to Company's finances, general description of terms

Convertible Debt: Terms (check all that apply)

Discounted conversion features (i.e. converts at 20% discount to next equity financing, convertible at a per share value lower than the Copmany's current fair value)? Convertible immediately? Convertible at maturity? Convertible contingent upon future events (i.e. next equity financing, upon IPO, etc)?

Describe the nature and extent of deferred comp arrangements (i.e. how many employees deferred, extent of use (i.e. is this a large number relative to the organizations finances), how long outstanding, when will it be repaid)?

Additional notes regarding of capital structure

Has the company earned or recognized any revenues to date?*

Description of Revenues: Volume of transactions (i.e. lots of small transactions, handful of large contracts, etc), sources of transaction (i.e. all through website, via 3 brick-and-mortar stores, Kickstarter pre-sales), brief description of the systems/controls around revenues, any other pertinent information on revenues

Does the Company sell physical goods?

Please describe the Company's system/process for tracking inventory and expensing out to cost of goods sold

Inventory: Please describe where inventory is held, if fulfillment is in house or outsourced, and whether/how inventory counts are performed

Expenses: Please describe the main expenses of the Company (i.e. payroll is ~75%, other large expenses are rent, software development, and online marketing)*

Does the company have software development expenses?*

Please describe the current state of the software development, and that which applies to the year to be audited/reviewed (i.e. has minimum viable product been completed, full product completed and being marketed/sold/utilized, dates which such were achieved)

Related party transactions: Please describe any related party transactions the Company has conducted (i.e. founder owed money from Company, Company loaned money to officer, Company receives marketing services from a company owned by a director, Company shares working space with a related company (rent allocation), etc)*

Pre-inception Expenses: Did the Company incur expenses prior to formation that have been, or should be, pulled into the Company at inception date?*

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