Prospective Business Form – Bloom CPAs and Advisors

Prospective Business Client Form

Please complete this short questionnaire and we will be in touch shortly.

If you need assistance with the form, please contact us at info@bloom.cpa or 321-752-9967 and we would be glad to further assist you.

Prospective Business Client Form

Business Name

Date Established

Business Website

Applicant’s First Name

Applicant’s Last Name

Business Phone

Applicant’s Title

Applicant’s Email

Applicant’s Phone/Mobile

Business Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Preferred Method of Contact

Main POC First Name

Main POC Last Name

Main POC Email

Main POC Title

What type of business?

Please list the names of all Shareholders/Offices/Members/Owners”

What service does your business provide?

Have you worked with an accountant previously?

If yes, please provide their name and reason for leaving.

Latest tax year filed with IRS:

Are you behind on any filings or payments?

If yes, please provide an explanation.

Are you involved in any lawsuits with your business?

Have you ever been audited by any government agencies?

If yes, please provide an explanation:

Have you filed bankruptcy?

What year did you file bankruptcy?

How did you hear about Bloom CPAs and Advisors?

Reason for contact Bloom CPAs and Advisors

Date / Time