New Client Form

New Client Form

For Estimated Tax Withdrawals and Payments
Please review the Information Sheet on our website to ensure you understand the service Daly & Co. will provide. Then, complete all of the information below. The Taxpayer Personal Information section should match your tax returns. You will need to reference your 2021, 2022, and 2023 tax returns to complete the Tax Verification section of this form (verification is required by the IRS). Once this form is submitted, an engagement letter and authorization form will be prepared and emailed to you.
Taxpayer Personal Information
For the Taxpayer Listed First on Your Tax Return:
First Name (include middle initial if it is shown on your tax returns)
Last Name
Date of Birth

MonthDayYear
Date
Social Security Number or Taxpayer ID
Taxpayer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email address
example@example.com
Phone Number
Taxpayer PIN
Create a PIN number to use for estimated tax payments (choose any 5 digits except all of the same number. It can be the same as your spouse's PIN.)
Filing Status for this year
For the Spouse Listed Second on Your Tax Return, if applicable:
Spouse First Name
(include middle initial if it is shown on your tax returns)
Spouse Last Name
Spouse Date of Birth

MonthDayYear
Date
Spouse Social Security Number or Taxpayer ID
Spouse Address, if different from taxpayer's

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse Email address
example@example.com
Spouse Phone Number
Spouse PIN
Create a PIN number to use for estimated tax payments (choose any 5 digits except all of the same number. It can be the same as your spouse's PIN.)
Which email address should be used for communication from Daly & Co.?

TaxpayerSpouseSend it to both emails
Tax Account Verification
Taxpayer Account Verification is required by the IRS to make payments. The information below should match your tax returns for the years indicated below. Please fill out the information below for all of the years listed:
2021
Taxpayer Listed First on 2021 Tax Return
Spouse Listed Second on 2021 Tax Return
Filing Status for 2021
2021 Adjusted Gross Income ("AGI") per tax return
Address on 2021 tax return, if different from Personal Info section above.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your country of residence in 2021 if not the USA
2022
Taxpayer Listed First on 2022 Tax Return
Spouse Listed Second on 2022 Tax Return
Filing Status for 2022
2022 Adjusted Gross Income ("AGI") per tax return
Address on 2022 tax return, if different from Personal Info section above.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your country of residence in 2022 if not the USA
2023
Taxpayer Listed First on 2023 Tax Return
Spouse Listed Second on 2023 Tax Return
Filing Status for 2023
2023 Adjusted Gross Income ("AGI") per tax return
Address on 2023 tax return, if different from Personal Info section above.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your country of residence in 2023 if not the USA
Bank Account for Withdrawals

You can use a personal or business checking or savings account for your auto-pay withdrawals. The bank account must be located in the United States. Your bank account will not be charged yet. We will use the information from this New Client Form to prepare an engagement letter which outlines our agreement and your withdrawal schedule. You must sign and return the engagement letter. You will receive the engagement letter via email. Review it, sign it, and return to us to finalize your enrollment.
Bank Name
Bank Routing Number
Bank Account Number
Is it a Personal or Business Account
Account Type: checking or savings
Primary Person on the Account
If a business account, list your business' name
Address on the Bank Account, if different than Personal Info section above.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Estimated Taxes Remaining
List the total amount you want withheld for the remainder of the current year for each government agency below. Daly & Company will use your total to calculate the semi-monthly amount that will be withdrawn on the 1st and 15th of each month according to a withdrawal schedule. You will be provided with the withdrawal schedule in the engagement letter. The engagement letter will be sent after we have reviewed this completed New Client Form.

List the Remaining Total Estimates for Each Government Agency that Need to be Paid

Example: You want to pay $10,000 per quarter to the IRS and $1,000 per quarter to NJ.

Example 1: You are enrolling for January 1st and have not paid any estimated taxes for the current year yet, enter $40,000 for Federal and $4,000 for NJ below.

Example 2: You are enrolling on June 20th and have already paid your first (4/15) and second (6/15) estimates, your remaining payments to the IRS would be $20,000 and $2,000 for NJ.

Leave blank any states that are not applicable.
Federal Total Estimate Remaining
NJ Total Estimate Remaining
NY Taxpayers - Enter your login information for NY's tax account website.
Username and password for NY
NY Total Estimate Remaining
CT Total Estimate Remaining
PA Total Estimate Remaining
List any other states or cities and the total estimate remaining:
List the date(s) you want the withdrawals from your bank account to begin, if not ASAP:
State any other relevant information you would like us to know:
Should be Empty:

New Client Form

Taxpayer Personal Information

Tax Account Verification

2021

2022

2023

Bank Account for Withdrawals

Estimated Taxes Remaining