CLIENT APPLICATION

Tax Preparation Client Intake Form
FILING STATUS*

SINGLEHEAD OF HOUSEHOLDMARRIED JOINTLYMARRIED SEPARATLEYQUALIFYING WIDOWER

TAXPAYER INFORMATION
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
EMAIL*
example@example.com
PHONE NUMBER*
Please enter a valid phone number.
CELL PHONE COMPANY*
(Ex. AT&T, Verizon, T-Mobile, and ETC)
SSN*
DATE OF BIRTH*

MonthDayYear
Date
UPLOAD PICTURE OF ID AND SOCIAL SECURITY CARD

Cancelof
PLEASE CHECK ALL THAT APPLIES

Are you a full-time studentAre you totally and permanently disabledAre you legally blindIs this individual dependent of other

SPOUSE INFORMATION
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
SSN
UPLOAD PICTURE OF ID AND SOCIAL SECURITY CARD

Cancelof
PLEASE CHECK ALL THAT APPLIES

Are you a full-time studentAre you totally and permanently disabledAre you legally blindIs this individual dependent of other

Please complete all information for dependents.

Childcare Information

Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true. I allow Wilder Tax-N-Go LLC to capture my sensitive data like personal id, government id, social security number (SSN), and other information. I have read the terms and conditions and privacy policy of ABC Financial. By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
TAXPAYER SIGNATURE*

Clear
DATE SIGNED*

MonthDayYear
Date
SPOUSE SIGNATURE

Clear
DATE SIGNED

MonthDayYear
Date
Should be Empty:

Tax Preparation Client Intake Form