Individual Tax Intake Form

Weafers Tax Service - Individual Tax Intake Form

For Personal Income Tax Preparation

853 Lane Allen Rd., Lexington, KY 40504

Main Line: 859-281-1040 I Text Line: 859-286-4540 I Fax: 866-884-6296 I Email: docs@weafertax.com
1. General Information:
Todays Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
How did you hear about us Referral Returning Client Website Social Media Other
Referred by if applicable
2. Taxpayer Information:
Full Legal Name
Primary Contact Full Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearPrimary Contact DOB
Social Security Number
Primary Contact Social Security #
Occupation
Primary Contact Occupation
Address

Address

Street Address Line 2

CityState

ZIP
Mobile Phone:
Primary Contact TelephoneFormat: (000) 000-0000.
Email
Primary Contact Email Address
3. Spouse Information (if applicable):
Full Legal Name
Spouse Full Legal Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearSpouse DOB
Social Security Number
Spouse Social Security #
Occupation
Spouse Occupation
Spouse Address (if different than Primary contact)

Address

Street Address Line 2

CityState

ZIP
Spouse Mobile Phone
Format: (000) 000-0000.
Email
Spouse Email Address
4. Filing Status (choose one):
Type a question
5. Dependent Information (if applicable):
Name
Dependent #1 Info
Relationship
Dependent #1 Info
DOB
Dependent #1 Info
SSN
Dependent #1 Info
Name
Dependent #2 Info
Relationship
Dependent #2 Info
DOB
Dependent #2 Info
SSN
Dependent #2 Info
Name
Dependent #3 Info
Relationship
Dependent #3 Info
DOB
Dependent #3 Info
SSN
Dependent #3 Info
Name: (Add additional dependents as needed in Notes Section below)
6. Direct Deposit Information (for applicable Tax Refunds)
Bank Name
Routing Number
Account Number
Bank Account Type:
Please ensure accuracy; Weafers Tax Service is not responsible for delays due to incorrect bank information.
7. Additional Notes / Comments:
Additional Comments:
Tax Accountant Requested (Type Name)
MANNY | AARON | TRAVIS | NO PREFERENCE
9. Acknowledgement & Signature:
Name

First NameLast Name
Client Signature and Date
Office Use Only
Entered By
Entered Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Weafers Tax Service I Office (859) 281-1040 I Fax (866) 884-6296 I docs@WeaferTax.com
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