2021 Client Information Form

Client Information Form

For Tax Year 2021
Date *

Month Day Year
Client Status: *
Filing Status: *
Are you any of the following: *

Military active duty or Veteran 1st Responder Over the age of 65 None
Taxpayer Name: *

First Name Middle Name Last Name
Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Taxpayer SSN: *
Taxpayer Occupation: *
Taxpayer DOB: *

Month Day Year
Taxpayer Drivers License #: *
Spouse Name:

First Name Middle Name Last Name
Spouse SSN:
Spouse Occupation:
Spouse DOB:

Month Day Year
Spouse Drivers License #
Taxpayer Phone Number: *

Area Code Phone Number
Spouse Phone Number:

Area Code Phone Number
Taxpayer E-mail:
example@example.com
Spouse E-mail:
Preferred method of contact:

Phone Text Email
Did you/your spouse purchase health insurance through the Marketplace in 2021?
Do you have any dependents?

Yes No
Dependent #1 Name:

First Name Middle Name Last Name
Dependent #1 Relationship:
Dependent #1 SSN:
Dependent #1 DOB:

Month Day Year
Dependent #2 Name:

First Name Middle Name Last Name
Dependent #2 Relationship:
Dependent #2 SSN:
Dependent #2 DOB:

Month Day Year
Dependent #3 Name:

First Name Middle Name Last Name
Dependent #3 Relationship:
Dependent #3 SSN:
Dependent #3 DOB:

Month Day Year
Dependent #4 Name:

First Name Middle Name Last Name
Dependent #4 Relationship:
Dependent #4 SSN:
Dependent # 4 DOB:

Month Day Year
Estimated Tax Payments Made

If applicable
Did you make any estimated payments for 2021?

Yes No
1st Quarter (enter date & amount paid):
2nd Quarter (enter date & amount paid):
3rd Quarter (enter date &amount paid):
4th Quarter (enter date & amount paid):
Bank Information:
If you are due a refund, would you like direct deposit? *

Yes No
If you have tax due, would you like it to be automatically withdrawn from your bank account? *

Yes No
Bank Name:
Account Type:

Checking Savings
Account Number:
Routing Number:
Would you like us to use the bank account listed above to pay for the preparation of your tax return, along with any audit protection plans you have selected? *

Yes I give permission for the direct payment via ACH, and will complete the Direct Payment Authorization form. No I do not give permission for the direct payment via ACH.
Please find and read our fee schedule and deposit requirement listed on the resource page *

I acknowledge I have read and understand the fee schedule I acknowledge I have read and understand the requirement of deposit
Additional Questions
Did you receive the 3rd stimulus payment of $1,400 for yourself, spouse and dependents? *

Yes No
Did you receive any Advanced Child Tax Credit payments during 2021? *

Yes No N/A
If yes, please provide the total amount received and/or Letter 6419 from the IRS.
I understand that failure to answer the questions above or providing incorrect information will delay the processing of my return with the IRS *

I understand and have provided verified information
Did you make any charitable contributions during 2021? *

Yes No
If yes, please list the organizations and totals given.
Audit Protection Plans
Please add the following plan to my 2021 tax invoice *

$29.00 Basic Audit Protection Plan for 2021 tax year $59.00 Core Audit Protection Plan for 2021 tax year $99.00 Premium Audit Protection Plan for 2021 tax year None
Business Account Information

If applicable
Do you need a business return prepared?

Yes No
Business Name:
Business FEIN
Business Type:

Sole Proprietorship Partnership S-Corp C-Corp Trust Estate
Do you need a franchise tax report prepared?

Yes No
Texas Comptroller's Taxpayer #
XT#
Have you brought all 1099's issued to your business?
Do You need to issue 1099's?
I understand that I need to include a summary of all of my business receipts and expenses. Returns with no summary will incur additional preparation fees. *
Any Additional Information:
Should be Empty:

Client Information Form

Estimated Tax Payments Made

Bank Information:

Additional Questions

Audit Protection Plans

Business Account Information