Client intake form

TAX PREPARATION MAIN INFORMATION SHEET

TAXPAYER INFORMATION (PLEASE PRINT):

SPOUSE INFORMATION (PLEASE PRINT):

CURRENT ADDRESS (PLEASE PRINT):

TAX PREPARATION MAIN INFORMATION SHEET
TAXPAYER INFORMATION (PLEASE PRINT):
SOCIAL SECURITY NUMBER:
DATE OF BIRTH

MonthDayYear
Date
EMAIL:
example@example.com
SOCIAL SECURITY NUMBER:
FIRST NAME:

First NameMiddle InitialLast Name
SPOUSE INFORMATION (PLEASE PRINT):
DATE OF BIRTH

MonthDayYear
Date
FIRST NAME:

First NameMiddle InitialLast Name
EMAIL:
example@example.com
CURRENT ADDRESS (PLEASE PRINT):
ADDRESS:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
MOBILE PHONE:
Format: (000) 000-0000.
MOBILE PROVIDER:
HOME PHONE NUMBER:
Format: (000) 000-0000.
Dependent Information - Do not include yourself or your spouse
Please list everyone who lived in your home and anyone living outside your home that you support

Dependent Information - Do not include yourself or your spouse Please list everyone who lived in your home and anyone living outside your home that you support

1. Would you like for your refund to be direct deposited in your bank account? YES OR NO
Please Upload Drivers License

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Please upload Income documents

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Please upload other documents

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Did You Receive a PTIN?
Would You Like to Apply for an Advance?
(If yes, you will need a voided check or a bank statement with your routing and account number)
2. How did you hear about {INSERT COMPANY NAMER}
If someone referred you to {INSERT COMPANY NAME}, please list their name below: (New Client Only)
Referred By:
Please indicate that the information above is correct best to your knowledge:
Your Signature:
1 Date Signed

MonthDayYear
Date
Spouse Signature:
2 Date Signed

MonthDayYear
Date
{INSERT COMPANY NAME}
Should be Empty:

NAME: (First, Middle, Last) Print Exactly As Social Security Card Reads

Social Security No.

Date of Birth MM-DD-YY

Relationship

Full Time Student

Totally Disabled