Client Information Form

Client Information Form

Complete the client information form using the extracted fields from the referenced PDF. All phone-related fields must use the Phone Number field type. All fields are optional unless the original document explicitly marks them required.
Taxpayer Information
Full Name

First NameMiddle NameLast Name
Taxpayer SSN
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Occupation
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Spouse Information
Spouse Full Name

First NameMiddle NameLast Name
Spouse Identification Number
Spouse Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Spouse Occupation
Spouse Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Spouse Email
example@example.com
Spouse Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Dependents
Dependent 1 Name

First NameLast Name
Dependent 1 Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Dependent 1 SSN
Dependent 1 Relationship
Dependent 2 Name

First NameLast Name
Dependent 2 Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Dependent 2 SSN
Dependent 2 Relationship
Dependent 3 Name

First NameLast Name
Dependent 3 Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Dependent 3 SSN
Dependent 3 Relationship
Dependent 4 Name

First NameLast Name
Dependent 4 Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Dependent 4 SSN
Dependent 4 Relationship
Document Checklist
W-2 Forms
1099 Forms
1098 Forms
Receipts for Charitable Contributions
Mortgage Interest Statement
Property Tax Statement
Medical Expense Records
Education Expense Receipts
Business Expense Receipts
Vehicle Mileage Log
Bank Statements
Prior Year Tax Return
Dependent Care Expenses
Provider 1 Name

First NameMiddle NameLast Name
Provider 1 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Provider 1 Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Provider 1 Identification Number
Provider 1 Amount Paid
Provider 2 Name

First NameMiddle NameLast Name
Provider 2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Provider 2 Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Provider 2 Identification Number
Provider 2 Amount Paid
Healthcare and Medical
Coverage period
Premiums paid
Out-of-pocket medical expenses
Prescription expenses
Dental expenses
Vision expenses
Health insurance mileage
Medical mileage
Marketplace statement
Did you have health coverage?
Other medical expenses
Other healthcare and medical amounts or notes
Education
Student 1 Name

First NameMiddle NameLast Name
Student 1 Years of Postsecondary Education
Student 1 Qualified Education Expenses
Student 1 Institution Name
Student 1 Institution Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Student 2 Name

First NameMiddle NameLast Name
Student 2 Years of Postsecondary Education
Student 2 Qualified Education Expenses
Student 2 Institution Name
Student 2 Institution Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Education Expense Type
Total Education Expenses
Itemized Deductions
Medical and dental expenses
State and local taxes
Real estate taxes
Home mortgage interest
Investment interest expense
Charitable contributions
Casualty and theft losses
Unreimbursed employee expenses
Other itemized deductions
Other
Business and Vehicle Use
Business use of vehicle
Vehicle owned or leased
Vehicle make
Vehicle model
Vehicle year
Business miles driven
Total miles driven
Date vehicle placed in service

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Business use percentage
Business vehicle notes
Yes/No Questions
Did you or your spouse have any self-employment income?
Did you receive any unemployment compensation?
Did you make any estimated tax payments?
Did you pay for child or dependent care expenses?
Did you contribute to an IRA or retirement account?
Did you have any health coverage for all months of the year?
Banking and Direct Deposit
Bank Name
Account Number
Routing Number
Account Type
ID and Driver’s License
Driver's License Number
State
Issue Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Expiration Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Spouse Driver's License Number
State
Issue Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Expiration Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Payment and Billing
Billing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Payment Method
Account Type
Cardholder Name
Card Last 4 Digits
Signatures
Taxpayer Signature
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Spouse Signature
Spouse Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Client Information Form

Taxpayer Information

Spouse Information

Dependents

Document Checklist

Dependent Care Expenses

Healthcare and Medical

Education

Itemized Deductions

Business and Vehicle Use

Yes/No Questions

Banking and Direct Deposit

ID and Driver’s License

Payment and Billing

Signatures