HALLER GROUP CLIENT INFORMATION
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Haller Group Services
Individual Tax Preparation
Business Tax Preparation
Bookkeeping
Retirement Planning
Tax Planning
Business Consulting
Payroll Services
Mortgage/Refinance
WHAT SERVICES ARE YOU INTERESTED IN?
WHEN WOULD YOU LIKE SERVICES TO START?
WHAT ACCOUNTING SYSTEM DO YOU USE?
WHAT PAYROLL SYSTEM DO YOU USE?
GENERAL INFORMATION
Taxpayer Name
First Name
Last Name
Date of Birth
/
Month
/
Day
Year
Date
SSN
Phone No
-
Area Code
Phone Number
E-Mail
example@example.com
Address
Spouse Name
Date of Birth
/
Month
/
Day
Year
Date
SSN
Spouse Phone
-
Area Code
Phone Number
Spouse E-Mail
example@example.com
DEPENDENT INFORMATION
Name
First Name
Last Name
Date of Birth
/
Month
/
Day
Year
Date
SSN
Relationship
Dependent of
Name
First Name
Last Name
Date of Birth
/
Month
/
Day
Year
Date
SSN
Relationship
Dependent of
DIRECT DEPOSIT INFORMATION
Name of Bank
Routing Number
Account Number
Account Type
Checking
Savings
Account Type
Money Market
Copy of voided check?
Yes
No
BUSINESS INORMATION
Legal Name
DBA
Primary Business Activity
E-Mail
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Incorporation
/
Month
/
Day
Year
Date
Tax ID
Number of Employees
Calendar / Fiscal Year?
If Fiscal, What is Year End?
Business Type
Sole Proprietor
Partnership
C Corp
S Corp
OFFICER INFORMATION
Name
Title
Percent Ownership
Name
Title
Percent Ownership
Name
Title
Percent Ownership
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