Prospective Individual 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 Individual Client Form

First Name

Last Name

Date of Birth

Phone/Mobile

Work Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Preferred Method of Contact

Spouse First Name

Spouse Last Name

Spouse Email

Spouse Occupation

Do you have any dependents?

Does your spouse have any dependents?

What is your filing status?

Do you have Ownership or Investment in any Business or are you a beneficiary of a trust?

If yes, please list:

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 filed bankruptcy?

Year bankruptcy was filed

How did you hear about Bloom CPAs and Advisors?

Reason for contact Bloom CPAs and Advisors

Date / Time