Client Information Form
Complete this form in its entirety for accurate tax filing.
Full Name of Taxpayer
*
First Name
Middle Name
Last Name
Suffix
Taxpayer Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Taxpayer Social Security Number
*
(000-000-0000)
What is your filing status?
*
Head of Household
Single
Married Filing Jointly
Married Filing Separately
Qualifying Surviving Spouse
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
How did you hear about us?
Returning Client
Referred
Flyer
Google
Social Media
Other
If referred, please share who referred you.
Full Name of Taxpayer's Spouse
First Name
Middle Name
Last Name
Suffix
Taxpayer's Spouse Birthday
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Taxpayer's Spouse Social Security Number
Taxpayer's Spouse Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Taxpayer's Spouse's Email
example@example.com
Taxpayer's Spouse's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Insurance Information
Do you have Marketplace health insurance (Healthcare.gov, Obamacare)?
*
Yes
No
Dependent Information
Dependent #1 Information
Dependent #2 Information
Dependent #3 Information
Dependent #4 Information
Refund Options
How would you like to receive your refund?
*
Direct Deposit
Check
Prepaid Visa
Bank Name
Checking/Savings ACCOUNT Number
Be certain to confirm the accuracy of this number as it could affect the timeliness of your refund.
Checking/Savings ROUTING Number
Be certain to confirm the accuracy of this number as it could affect the timeliness of your refund.
Attachments
Upload your valid ID or Driver's License for yourself and your spouse, Social Security Cards for yourself, your spouse, and dependents, as well as ALL of your tax documents (W2s, 1099s, 1098s, etc.) here. Appointments are subject to cancellation if all paperwork is not received prior to your scheduled appointment.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Signatures
Taxpayer Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Taxpayer Spouse Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: