Client Data Form

Name

Taxpayer First NameTaxpayer Last Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

D.O.B

Occupation:

Social Security Number:

Driver's License/ID #

Driver's License/ID State:

Phone Number:

Email

example@example.com

Spouse Information:

Spouse First NameSpouse Last Name

Spouse D.O.B:

Spouse Occupation:

Spouse Social Security Number:

Spouse Driver's License/ID #:

Spouse Driver's License/ID State:

Filing Status

Number of Dependent's:

Dependent One:

First NameLast Name

Dependent Social Security Number:

Dependent D.O.B:

Dependent Relationship:

Dependent Disable?

Student?

Dependent Two:

Dependent Two

Dependent First NameDependent Last Name

Dependent Social Security Number:

Dependent D.O.B:

Dependent Relationship:

College Student (If Yes, Please Upload Form 1099-G)?

Disable?

Income: (CHECK ALL THAT APPLY)

WOULD YOU LIKE AN ADVANCE?

Taxpayer One Driver's License/ID:

Spouse Driver's License/ID:

W2, 1099G, Etc

Income Documents

Social Security Card For Taxpayer

Social Security Card For Spouse

Social Security Card For Dependent

Would you like to add Audit Protection Plus?

Consent For Payment

We here at Jmeaux Tax Service LLC value the relationship we have with all of our clients. We are in the business to provide you with the absolute best service you can have. By saying that, we would like to remind you that we are providing you a service NOT a refund. You as a taxpayer have the choice to pay your tax preparation fee by one of the following: cash, money order, credit card, or directly from your refund*.

* If you choose to have the tax preparation fees taken from your refund and for whatever reason, your taxes are intercepted. YOU ARE STILL RESPONSIBLE FOR THE TAX PREPARATION FEES! Please contact us immediately at our office for payment or payment arrangments. By signing your return you are agreeing to pay the preparation fees regardless of whether your refund was received or not. After 90 days from the date the refund was scheduled to arrive if no payment or payment arrangement is made, we will be forced to put your account into collections and/or debit your bank account. We hope we never have to go this route, so please keep open communication with us so we can work with you!

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