Walt Tax (General Information Form)

Walt Tax

We understand tax preparation and assist with planning, to help you save money and pay less.
Name *

First Name Last Name
Email *
example@example.com
Phone Number

Area Code Phone Number
How did you hear about us? *

Facebook Instagram Referral Previous Client
If someone referred you, please type his or her name here.
How would you like to be contacted? *

Email Phone
What is the best day & time to contact you?
Would you like to make an appointment?
Job Title
example@example.com
Are you inquiring about business tax services?

Yes No Unsure
If so, what type of business do you have?
Ex: S-Corp, C-Corp, LLC
Did you file a 2020 tax return?

Yes No Unsure
What is your marital status as of December *

Single (Not Married) Married living with Spouse Married not living with spouse
Spouse Name (if applicable/filing jointly)

First Name Last Name
Spouse's Phone Number
Example: xxx-xxx-xxxx
Spouse's Email Address
Example: example@example.com
Spouse's Job Title
Home Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Are you self employed? *

Yes No
Did you and your spouse live apart during the year? *

Yes No Not Applicable
Did you support a child or family member for more than 6 months out of the year? *

Yes No
Are you on any Government Assistance *

Yes No Not Applicable
How many dependents are you claiming? *
How many months did your Dependent(s) live with you in 2021? (If all year, enter 12)
Are there any dependents in daycare?

Yes No
How would you like to receive your tax refund?

Check (Only available for in office visits) Direct Deposit
Which type of account would you like your refund deposited into?

Checking Account Savings Account
Can someone else claim you as a dependent?

Yes No
Did you have health insurance in 2021?

Yes No
Did you have health insurance for the entire year?

Yes No
Was your insurance through your employer?

Yes No
Did your dependents have health insurance for the entire year?

Yes No Not Appliable
Did you receive the first round of stimulus check? *

Yes No
Did you receive the second round of stimulus check?

Yes No
Were you or any of your dependents in college in 2021?

Yes No
Date

Month Day Year
Date
Type a question
Date

Month Day Year
Date
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform