New Customer Registration Form

Customer Registration Form

Please take a moment to provide the following details.
Primary Taxpayer*

First NameLast Name
DOB

MonthDayYear
Date
SSN
Current Address*

Street Address

CityState / Province

Postal / Zip Code
Phone Number*
E-mail
example@example.com
How Did You Hear about Wilder Power Taxes?

FacebookIn person/ FlyerEmailReferral
If referred , please list the person.
Select All Tax Years Need to be Filed

201920202021202220232024Other
** DO YOU OWE THE IRS ??**

YesNoI'm Not Sure
Filing Status

Head of HouseholdSingleMarried Filing JointlyMarried Filing Separately
DL Number
Expiration Date

MonthDayYear
Date
DL State
Name of Person who needs IPIN (if needed)
IPIN (If Needed)
If filing Jointly, what's the taxpayers name?

First NameLast Name
SSN
DOB

MonthDayYear
Date
Any Dependents?
If so, how many dependents are you claiming?

Dependents

	Name	SSN	DOB	Live with you more than 6 months?	Relation
Dependent
Dependent
Dependent
Dependent
Dependent
Dependent
Dependent

Income

W21099-NEC Or 1099- MISCUnemploymentTipsRental IncomePension / Retirement IncomeSelf Employment (Schedule C)Other
Bank Name
Routing
Accounting
Should be Empty: