Client Information Sheet

Some More Info.
Identity Protection PIN by the IRS
Health Care Coverage*

YesNo
If you had insurance through the marketplace, did you receive a 1095-A Health Insurance Marketplace statement? (Not providing form IRS could delay your refund)
How did you hear about us?*

ReferralSocial MediaFlyer/PostcodeYard Sign
Referral's Name*

Dependants

Referrals

Questions, Comments, or Concerns
How would you like your refund?*

Direct DepositCheck
Bank Name:*
Routing # *
Account #*
Please attach the Copy(s) of Identification (ID), Copy(s) socials, w2(s), 1099(s), and all related taxes forms here:*

Cancelof
I confirm and agree that all information is correct.

I am giving Local Tax Pros permission to prepare all forms related to my tax return and I have signed all necessary forms to file my income tax return electronically. I take full responsibility for the accuracy of this client intake form and understand that Local Tax Pros holds no responsibility for any misrepresentation or false claims.
Tax Payer's Signature*

Clear
Spouse's Signature

Clear
Should be Empty:

Local Tax Pros