| Acme Corp | Doc. AC-104 Rev. 06/26 |
Client Service Intake RecordComplete all applicable sections. Print clearly. | |
| Section 1 - Requesting Party | |||
| Legal name | Jordan Lee | jordan@northstar.co | |
| Company | Northstar Operations | ||
| File ref. | ACME-26-0718 | Received | 06 / 03 / 2026 |
| Section 2 - Requested Packet Type | ||
| 1 | Service agreement | |
| 2 | Client onboarding | |
| 3 | Insurance packet | |
| 4 | Vendor intake | |
| Section 3 - Client Acknowledgment | ||
Client signature | 06 / 03 / 2026 Date | Authorized |
Official Use Only - Do Not Fill Internal processing and review fields | |||||
| Intake clerk | Queue code | Reviewer | Approved Yes No | Archive box | Scan ID |
| Internal comments | Follow-up required NoneCallEmail | Disposition notes / retention schedule | |||

