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Client Registration Form
CLIENT INFORMATION
Name:
*
First Name
Last Name
Date of Birth:
*
-
Month
-
Day
Year
Date
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email:
*
example@example.com
Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Occupation:
*
Referred By:
BANK INFORMATION
Bank Name (For Direct Deposit of Refund):
*
Account Holder's Name (as shown on bank account):
*
First Name
Middle Name
Last Name
Checking or Savings?
*
Personal Checking
Personal Savings
Business Checking
Business Savings
Routing Number:
*
Account Number:
*
STATE ID
State ID (Front):
*
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State ID (Back):
*
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TAX QUESTIONNAIRE AND DOCUMENTS
Filing Status?
*
Single
Head of Household
Married Filing Jointly
Married Filing Separately
Qualifying Widow(er)
Filing Married Jointly or Separate, Please Enter Spouse Information Below:
First Name
Last Name
Date of Birth:
-
Month
-
Day
Year
Date
Spouse State ID (Front):
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Spouse State ID (Back):
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Will you be claiming children or dependents?
*
Yes
No
Child/Dependent
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
2nd Child/Dependent
First Name
Last Name
Date of Birth:
-
Month
-
Day
Year
Date
3rd Child/Dependent
First Name
Last Name
Date of Birth:
-
Month
-
Day
Year
Date
4th Child/Dependent
First Name
Last Name
Date of Birth:
-
Month
-
Day
Year
Date
Do you pay for child care?
*
Yes
No
Do you own a home or rental property? (Form 1098)
*
Yes
No
If 'Yes', upload Form 1098 here
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Did you attend College this year? (Form 1098T)
*
Yes
No
If 'Yes', upload Form 1098T here:
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Do you have any income from self-employment/1099?
*
Yes
No
Do you have any stock options or other complex investments?
*
Yes
No
Did you purchase Health Insurance through the "Health Marketplace"?
*
Yes
No
Did you receive a 1095-A Medical Tax Form?
*
Yes
No
If 'Yes', upload Form 1095-A here:
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Tax Document Upload 1
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Tax Document Upload 2
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Tax Document Upload 3
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Tax Document Upload 4
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Tax Document Upload 5
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Tax Document Upload 6
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Tax Document Upload 7
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Tax Document Upload 8
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Terms and Conditions
Submit
Should be Empty: