Flourish Financial Group Tax Client Intake

Client Intake Form

Hello, and thank you for considering Flourish Financial Group for all your financial needs! Please fill out this form and upload your documents to begin the filing process. I will reach out to you with your documents for review and signature before submitting your return to the IRS. Rooted in Growth, Built for Prosperity.
Taxpayer’s Name

First NameLast Name
Social Security Number
Date of birth

MonthDayYear
Date
Occupation
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Spouse Information

First NameLast Name
Social Security Number
Date Of birth

MonthDayYear
Date
Address You Want to Use on Return

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is This The Same Address Filed On 2024 Return?
Previous Address (Only if you have moved since 2024 return):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Filing Status
Dependent #1

First NameLast Name
Social Security Number
Date of birth

MonthDayYear
Date
Relationship
Dependent #2

First NameLast Name
Social Security Number
Date of birth

MonthDayYear
Date
Relationship
Dependent #3

First NameLast Name
Social Security Number
Date of birth

MonthDayYear
Date
Relationship
Dependent #4

First NameLast Name
Social Security Number
Date of birth

MonthDayYear
Date
Relationship
Dependent #5

First NameLast Name
Social Security Number
Date of birth

MonthDayYear
Date
Relationship
Did you pay someone to watch your child(ren)?
Do you or any other persons on this return receive an IP PIN from the IRS?
If “yes”, list all names and corresponding IP PINS below.
Did you collect social security or retirement income?
Did you purchase health insurance through healthcare.gov marketplace (Obama Care)?
If yes, did you receive a 1095-A Form from the Marketplace?
Were you ever disallowed the E.I.T.C prior to this year?
Did you make college tuition payment and received a 1098-T Form?
Do you have any other income other than your W2(s)?
If so, what kind of income?
Are you delinquent in any of the following?
Did you file 2024 taxes?
Did you successfully receive your 2024 taxes?
What years did you successfully file taxes?
Will you be looking to purchase a home within the next 1-2 years? If so, please give details.
How would you like to receive your refund?
File Upload

Valid photo identification
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File Upload

Taxpayer Social Security Card
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File Upload

Dependent Social Security Card
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File Upload

Dependent Social Security Card
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File Upload

Dependent Social Security Card
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File Upload

Dependent Social Security Card
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File Upload

Dependent Social Security Card
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File Upload

W2(s)
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File Upload

1099(s)
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File Upload

Other Forms
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Bank Name:   Type a label*
Routing Number (VERIFY):   Type a label*
Account Number (VERIFY): Type a label*
PLEASE READ CAREFULLY: I, hereby, state that all the information above is true to the best of my knowledge and that I am allowing Flourish Financial Group LLC to prepare my taxes based on the information I provided. I understand that I am financially responsible for any outstanding balance due to any false information given. If there is a balance due, I must pay the tax preparation fee upfront. If for any reason I owe an entity and they take the entire refund, I am STILL responsible to pay the tax preparation fee for services rendered. If for any reason an amendment has to be filed with no fault of the tax preparer, an upfront fee of $350 is required. Fees for tax preparation are determined on a case by case basis dependent on your tax situation. By signing this form you agree to be taken on as a client by the tax preparer and agree to permissive use of your tax information to file a return on your behalf. If for any reason you should decide not to file unless an initial estimate was agreed upon, a consultation fee in the amount of $150 is owed to protect time consulting as a professional. Please view your tax return, which is emailed to you (it is sent prior to submission). ALL FEES (bank and service fees) are found in the return and are non-refundable nor negotiable. Please utilize www.irs.gov for all federal refund tracking. Please utilize your state Department of Revenue site for any State Refund tracking. Do NOT add the amounts together. Federal taxes are federal, and state taxes are state when tracking your status. Please allow 8 weeks to surpass from the date of submission before calling the IRS, if you have any tracking questions. For any direct assistance please email: hello@flourishfinancialgroup.net or call the IRS for all updates at 800-829-1040
Signature understanding and agreeing to the terms listed above.

You understand and agree to the terms below
How did you hear about us?
Were you referred to us? If so, please list their name here so we can thank them:
Flourish Financial Group also provides credit repair and business funding services. Would you be interested in booking a free consultation to turn your financial goals into your reality?
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