AnyTime Tax

Tech4Tax

Tax Prep Client Information
Tax Preparer: Anita Lewis
How did you hear about us?*

FacebookInstagramGoogleReferred by someone?
If someone referred you please provide name
Full Name*

First NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
example@example.com
Do you have dependents under 18?*

YesNo
Do you own a business?*

YesNo
If yes Select Entity Type
Business Name
Are you Self Employed?*

YESNO
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Upload W2

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Upload 1099S/ Business Income

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Upload receipts to prove expenses

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Upload receipts to prove expenses

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The Above Information was given to Tech4Tax LLC . I the taxpayer, certify that all the information is correct to the best of my knowledge and I have receipts and bank statements as proof of my expenses.
Tax Payer Information
Tax payer's Name*

First NameLast Name
Tax Payer's Phone Number*

Area CodePhone Number
Tax Payer's Date of Birth*
Example 01/01/2000
Tax Payer's Social Security Number*
Example 111-11-1111
Other
Tax Payer's Job Title*
Tax Payer's Email
example@example.com
Spouse Information
Spouse Name

First NameLast Name
Spouse SSN
Example 111-11-1111
Spouse Date of Birth
Example 01/01/2000
Spouse Phone Number

Area CodePhone Number
Spouse Job Title
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse Email
Example@Example.com
Did you and your spouse live apart during the year?*

YESNONOT APPLICABLE
What was your Marital Status as of December?*

Single (Not Married)Married (Living with Spouse)Married (Not Living with Spouse)WIDOW (ER)
Did you pay over half the expenses for maintaining your residence for the entire year?*

YESNO
Did you support a child or family member for more than 6 months out the year?*

YESNO
How many dependents are you claiming?*
Can someone else claim you as a dependent*
Dependent Information
Dependent # 1

First NameLast Name
Dependent #1 Date of Birth
Example 01/01/2000
Dependent #1 SSN
What is Dependent's relationship to you
Example: Son, Daughter, etc
How many months out the year did this dependent live with you (If all year enter 12) Ex: 12
Upload Dependent #1 SS Card

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Dependent #2
Dependent #2 Full Name

First NameLast Name
Dependent #2 Date of Birth
Example 01/01/2000
Dependent #2 SSN
Example 111-11-1111
What is Dependent's relationship to you
Example: Son, Daughter, etc
How many months out the year did this dependent live with you (If all year enter 12) Ex: 12
Upload Dependent #2 SS Card

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Do you need to add more dependents?
Are any of your dependents in daycare? If so upload the form you received from your daycare provider

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Direct Deposit Information

To receive your refund via Direct Deposit you must provide banking information..
Name of Bank*
What type of account would you like your refund deposited to?*

CheckingSavingsOther
Routing Number*
Bank Account Number*
Insurance Information
Did you have health insurance for the entire year?*
Was your insurance through your employer?*

YESNO
Was your insurance through Medicaid*

YESNO
Was your insurance through the Affordable Cares Act (The Marketplace)*

YESNO
Did your Dependents have health insurance for the entire year?*

YESNONOT APPLICABLE
Was your dependents insurance through your employer?*

YESNONOT APPLICABLE
Was your dependents insurance through Medicaid?*

YESNONOT APPLICABLE
Was your dependents insurance through the Affordable Care Act?*

YESNONOT APPLICABLE
Have you ever been denied Earned Income Credit?*

YESNO
Who was your dependents insured with*
Upload Tax Payer's and Dependent(s) Insurance Documents

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Additional Credits
Were you or any of your dependents in college?

YESNO
Please Upload 1098T

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Client Nonpayment/Offset Clause
CLIENT NON PAYMENT/OFFSET CLAUSE

At Tech4Tax, we strive to assist all of our clients in their tax needs, however we understand that situations arise. If your refund is offset by the IRS, student loans, child support or your check is mailed, you are still obligated to pay our company the fees associated with filing your tax return.

By signing this agreement you acknowledge that if payment is not made in full with in 30 days legal actions will be sought to resolve payment
Tax Payer's Signature*
Additional Services
At Tech4Tax we do more than just taxes. Please check below if you would be interested in any of the additional services we provide. We will schedule a time to speak with you ar a later time.

You can also visit us at www.tech4tax.com
Interested in Tech4Tax Additional Services*

YESNO
By signing Below
I am giving Tech4Tax, LLC permission to prepare all forms related to my tax return; to apply for and secure RAC's and RAL's on my behalf; and sign all necessary forms and file my taxes electronically. I take full responsibility for the accuracy of this form and understand that Tech4tax LLC and/or associated affiliates hold no responsibility for any misrepresentation or false claims.
Signature*
Date*

MonthDayYear
Date
Spouse Signature (If No Spouse Leave Blank)
Date

MonthDayYear
Date
Ask a question
Upload Tax Payer's Drivers License or State ID*

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Upload Spouse Drivers License or State ID

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Upload Taxpayer's SS Card *

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Upload Spouse SS Card

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Upload Dependent(s) Proof of Residency

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Utility Bill, Paystub etc Cancelof
Upload Dependent(s) Birth Certificate(s)

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SAY CHEESE!! Upload a photo of you....

Please Provide 2 Referrals

	Full Name	Contact Number
1
2

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Tech4Tax

Tax Preparer: Anita Lewis

Tax Payer Information

Spouse Information

Dependent Information

Dependent #2

Direct Deposit Information

Insurance Information

Additional Credits

Client Nonpayment/Offset Clause

Additional Services

By signing Below