Client Information Form

Client Information Form

Complete this form in its entirety for accurate tax filing.
Full Name of Taxpayer*

First NameMiddle NameLast NameSuffix
Taxpayer Date of Birth*

MonthDayYear
Date
Taxpayer Social Security Number*
(000-000-0000)
What is your filing status?*

Head of HouseholdSingleMarried Filing JointlyMarried Filing SeparatelyQualifying Surviving Spouse
Address*

Street Address

Street Address Line 2

CityState

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 ClientReferredFlyerGoogleSocial MediaOther
If referred, please share who referred you.
Full Name of Taxpayer's Spouse

First NameMiddle NameLast NameSuffix
Taxpayer's Spouse Birthday

MonthDayYear
Date
Taxpayer's Spouse Social Security Number
Taxpayer's Spouse Address

Street Address

Street Address Line 2

CityState

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)?*

YesNo
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 DepositCheckPrepaid 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.*

Cancelof
Signatures
Taxpayer Signature*
Date*

MonthDayYear
Date
Taxpayer Spouse Signature
Date

MonthDayYear
Date
Should be Empty:

Client Information Form

Insurance Information

Dependent Information

Refund Options

Attachments

Signatures