LFR Financial Client Intake Form

“Feel The LFR Financial Difference”
Welcome to LFR Financial. Please complete this form to provide us with the information to best serve you. If you have any questions please email us. We look forward to serving you!
Client Intake Form
Tax Payer

First Name Last Name
Occupation
SSN
DOB

Month Day Year
Phone Number
Please enter a valid phone number.
Email
example@example.com
Filing Status
Identity Protection Pin (IP PIN)
Spouse

First Name Last Name
Occupation
SSN
DOB

Month Day Year
Phone Number
Please enter a valid phone number.
Email
example@example.com
Identity Protection Pin (IP PIN)
If you had insurance through the marketplace, did you receive a 1095-A Health Insurance Marketplace Statement? (Failure to provide this form can delay your refund)
Health Care Coverage?

Yes No
Have you moved since filing your last return?

Yes No
Current Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
How did you hear about us?

Client Referral Social Media Flyer/Postcode Yard Sign
Client Name (if Referred)
Did you receive your first stimulus payment?

Yes No
Did you receive your second stimulus payment?

Yes No
If you were self employed in 2020, were you unable to perform services because of certain corona virus related circumstances?

Yes No

Dependents

Legal Name

Relationship

DOB

SSN #

How would you like your refund?

Direct Deposit Prepaid Card Check
Bank Name
Routing #
Account #
Preferred Method of Contact
Please attach a Copy(s) of Identification card, social securit, w2(s), and all related tax documents here:

Cancel of
Please check and confirm all names and numbers, and bank account information are all correct before submitting.
I confirm and agree that all information is correct.

I agree
I am giving LFR FINANCIAL permission to prepare all forms related to my tax return and I have signed all necessary forms to file my income tax return electronically. I take full responsibility for the accuracy of this client intake form and understand that LFR FINANCIAL holds no responsibility for any misrepresentation or false claims.

I agree
Tax Payer Signature

Clear
Spouse Signature

Clear
Should be Empty:

“Feel The LFR Financial Difference”