Client Information Form

Client Information Form

Please fill out form completely for accurate estimate
Select your filing status*

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointlyQualifying Widower
Select your tax preparer*
Who referred you? Enter N/A if not applicable.*
If filing Head of Household, you must present one of the following to use this filing status. Select the one that you will upload to be approved for HOH filing status.

LeaseUtility BillMortgage Statement

Spouse Information
This section only needs to be completed if you are Married Filing Separately or Married Filing Jointly. Otherwise, you make skip to the next section.
Spouse Name

First NameLast Name
Spouse Date of Birth

MonthDayYear
Date
Spouse SSN
Spouse Occupation
Did you and you spouse live together for at least 6 months during the tax year?

YesNo

Have you and your dependent(s) had health insurance in the last 12 months? If yes, who is the insurance provider?

Did your dependent(s) live with you for at least 6 months of the tax year? Select N/A if not applicable.

YesNoN/A
Did you have any child or dependency care expenses? Such as daycare/babysitting?

YesNo

File Upload
Upload photo ID*

Cancelof
Upload Social Security Card

Cancelof
Upload Dependent(s) Social Security Card(s)

Cancelof
Upload W-2, 1099, and all other supporting documentation.

Cancelof
Upload 1098-T (college students)

You must upload 1098-T to receive education credit.
Cancelof
If filing HoH, please upload either utility bill, lease, or mortgage statement.

If not filing Head of Household, leave this field blank.
Cancelof
How would you like to receive your tax refund?
Would you like to receive your refund up to 5 days sooner with our Fast Forward program? a $25 fee applies.

YesNo
Would you like to apply for a refund advance loan up to $7000?

Direct Deposit Information

	Bank Name	Routing Number	Account Number
Enter Bank Data

We request that you upload a recent photo of yourself. This additional security measure is implemented to prevent tax and identity fraud. Your cooperation in ensuring the accuracy and authenticity of the information provided is appreciated.
Selfie Upload*

Acknowledgment & Signature
- I confirm that all information provided is true and accurate.
- I authorize Integrity Tax Firm to capture sensitive data such as my driver's license, social security number (SSN), taxpayer signature, and other information.
- By signing below you consent to Integrity Tax using the information provided to file your tax return and/or give a tax refund or tax liability estimate.
- If additional information is required, we will reach out to you promptly. We appreciate your cooperation and look forward to assisting you with your tax needs.
Date Signed

MonthDayYear
Date
Taxpayer Signature*

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