Tax Document Upload & Information Form

Tax Document Upload & Information Form

Upload your tax documents and complete the required personal, household (including children), and signature details.
Full Name

First NameLast Name
Date of Birth

MonthDayYear
Social Security
Spouse Full Name

First NameLast Name
Spouse Date of Birth

MonthDayYear
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Filing Status
Do you have dependents (children)?
Dependent Entries
Do you have W-2 income?
Do you have any other income (e.g., 1099s, interest, dividends)?
Did you have Marketplace Health Insurance?
If yes upload file

Cancelof
IP-PIN (Identity Protection Personal Identification Number)
Identification

Cancelof
Birth Certificate

Cancelof
W-2

Cancelof
Lease or Address Verification

Cancelof
Dependents
Additional Uploads

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Additional Comments or Notes
Were you referred?
If so, add name and phone number
Signature
Date

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