NEW PERSONAL CLIENT
INFORMATION SHEET
TAX PAYER INFORMATION:
Todays Date
/
Month
/
Day
Year
Date
Name
*
Date of Birth
*
/
Month
/
Day
Year
Date
Social Security
*
Occupation
Address
*
Address
Street Address Line 2
City
State
ZIP
Phone (Mobile)
*
Home
Work
Email
example@example.com
SPOUSE INFORMATION (IF APPLICABLE):
Spouse Name
Date of Birth
/
Month
/
Day
Year
Date
Social Security
Occupation
Address
Address
Street Address Line 2
City
State
ZIP
Phone (Mobile)
Home
Work
Email
example@example.com
DEPENDENT INFORMATION (IF APPLICABLE):
Type a question
Name
Relationship
Date of Birth
Social Security
Dependent #1
Dependent #2
Dependent #3
Do you have more than 3 dependents?
Please Select
Yes
No
DIRECT DEPOSIT INFORMATION:
Name of Bank
Routing
Account
Checking or Savings
If referred, please provide Name
OFFICE USE ONLY:
Tax Accountant
ENTERED BY
DATE
/
Month
/
Day
Year
Date
Weafers Tax Service / 853 Lane Allen Rd., Lexington, KY 40504 / 859-281-1040 /
Office@weafertax.com
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