Client Information Form
For Tax Year 2021
Date
*
-
Month
-
Day
Year
Date Picker Icon
Client Status:
*
Please Select
New Client
Returning Client
Filing Status:
*
Please Select
Married Filing Jointly
Married Filing Separate
Single
Head of Household
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
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Taxpayer SSN:
*
Taxpayer Occupation:
*
Taxpayer DOB:
*
-
Month
-
Day
Year
Date Picker Icon
Taxpayer Drivers License #:
*
Spouse Name:
First Name
Middle Name
Last Name
Spouse SSN:
Spouse Occupation:
Spouse DOB:
-
Month
-
Day
Year
Date Picker Icon
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?
Please Select
Yes
No
Do you have any dependents?
Yes
No
Dependent #1 Name:
First Name
Middle Name
Last Name
Dependent #1 Relationship:
Please Select
Son
Daughter
Step-Daughter
Step-Son
Foster Child
Other
Dependent #1 SSN:
Dependent #1 DOB:
-
Month
-
Day
Year
Date Picker Icon
Dependent #2 Name:
First Name
Middle Name
Last Name
Dependent #2 Relationship:
Please Select
Son
Daughter
Step-Daughter
Step-Son
Foster Child
Other
Dependent #2 SSN:
Dependent #2 DOB:
-
Month
-
Day
Year
Date Picker Icon
Dependent #3 Name:
First Name
Middle Name
Last Name
Dependent #3 Relationship:
Please Select
Son
Daughter
Step-Daughter
Step-Son
Foster Child
Other
Dependent #3 SSN:
Dependent #3 DOB:
-
Month
-
Day
Year
Date Picker Icon
Dependent #4 Name:
First Name
Middle Name
Last Name
Dependent #4 Relationship:
Please Select
Son
Daughter
Step-Daughter
Step-Son
Foster Child
Other
Dependent #4 SSN:
Dependent # 4 DOB:
-
Month
-
Day
Year
Date Picker Icon
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?
Yes
No
Do You need to issue 1099's?
Yes
No
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.
*
Yes
N/A
Any Additional Information:
Submit
Should be Empty: