Tax Assessment Application

Tax Assessment Application

Please fill in the questions to help us collect needed information to get started. Your information is confidential and will not be shared outside our office. Complete only the sections that apply to you or your business.
Full Name*

PrefixFirst NameLast Name
E-mail*
Birthdate*
Cell Phone Number*

Area CodePhone Number
Last 5 digits of your social security#*
If Married, Spouse Name

First NameLast Name
Spouse E-mail
example@example.com
Spouse Birthdate
Spouse Cell Phone Number

Area CodePhone Number
Last 5 digits of your spouse social security#
Your Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Opt in to receive text messages*

Yes, please send text messagesNo, do not send text messages
What is your budget?

Tax Planning Assessment $595-$3995

What forms do you have to help prepare or plan your taxes? Click on the boxes below. We will send you an invitation to log in our secure portal if you are a potential client for tax services.

	Primary Tax Filer	Spouse	Child or dependent	Business Proof
Social Security Card
State ID
W2 or 1099
Prior yr tax return
Investments/Retirement
Financial Statements
SOS Business Registration
Business EIN Proof

Do you have a business?*

YesNo
Do you have a business EIN #
Registered Business Name and Address

Business Name

Business Address

CityState / Province

Postal / Zip CodeCountry
Type of Business: According to the IRS EIN Approved form:

Single-member LLC classified as a disregarded entity isn't an employee of the LLC and the tax treated in the same manner as a sole proprietorshipLLC elect to be classified as an association taxable as a corporation, could be a paid employee of the LLCS CorporationPartnership
Business Start Date:

MonthDayYear
Date You Started or Plan to Start the Business
Enter Your Title or Position
Example: Officer, Manager, Owner, Director, etc.)
Tax Consent and Privacy Policy

Submitting this form is for potential clients and does not commit our firm to provide any services until a consent form is signed by the taxpayer.

"We do not disclose any non-public personal information about our customers or former customers to anyone, except as instructed to do so by such customers, or as required by law. Further exception is made with respect to directory information, limited to [describe directory information, e.g. name, address, and phone number], we may refer this information to an affiliated financial service professional where such referral is thought to be in your interest. Please advise us if instead you would require us to destroy all information, including basic directory information, confidential under any circumstance if service is not provided.
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