CLIENT FORM
How did you hear about us?
Facebook
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Referral
Previous Client
Tax Preparer Name
If someone referred you, please type his or her name here.
Are you trying to buy a new home within the next 2 years?
Yes
No
Are you interested in Book Keeping?
Yes
No
Email
example@example.com
Tax Payers Name
First Name
Last Name
Taxpayer's Phone Number
*
Example: xxx-xxx-xxxx
Taxpayer's Job Title
Taxpayer's Date of Birth
*
Example: 01/01/2001
Taxpayer's SSN
Example: xxx-xx-xxxx
Taxpayer's Email Address
*
Spouse's Full Name
First Name
Spouse's SSN
Example: xxx-xx-xxxx
Name
First Name
Last Name
Spouse's Date of Birth
Example: 01/01/2001
Spouse's Phone Number
Example: xxx-xxx-xxxx
Spouse's Email Address
Example: example@example.com
Taxpayer's SSN
Example: xxx-xx-xxxx
Spouse's Job Title
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you self employed?
*
Yes
No
Did you and your spouse live apart during the year?
*
Yes
No
Not Applicable
What is your marital status as of December
*
Single (Not Married)
Married living with Spouse
Married not living with spouse
Did you pay over half the expenses of maintaining your residence for the entire year?
*
Yes
No
Did you support a child or family member for more than 6 months out of the year?
*
Yes
No
If yes, did you live together at any time after June 30, 2023?
*
Yes
No
Not Applicable
Are you on any Government Assistance
*
Yes
No
Not Applicable
How many dependents are you claiming?
*
Please Select
0
1
2
3
4
5
Dependent #1
First Name
Last Name
Dependent #1 Date of Birth
01/01/2001
Dependent #1 SSN
What is Dependent #1's Relationship to you (son, daughter, etc.)?
How many months did Dependent #1 live with you in 2023? (If all year, enter 12)
Dependent #2
First Name
Last Name
Dependent #2 Date of Birth
Example: 01/01/2001
Dependent #2 SSN
How many months did Dependent #2 live with you in 2023? (If all year, enter 12)
What is Dependent #2's Relationship to you (son, daughter, etc.)?
Dependent #3
First Name
Last Name
Dependent #3's Date of Birth
01/01/2001
How many months did Dependent #3 live with you in 2023? (If all year, enter 12)
Dependent #3s SSN
Example: xxx-xx-xxxx
Dependent's #3 SSN
What is Dependent #3's Relationship to you (son, daughter, etc.)?
Dependent #4's First Name
First Name
Dependent #4's Last Name
Last Name
Dependent #4's Date of Birth
01/01/2001
Dependent #4's SSN
Example: xxx-xx-xxxx
What is Dependent #4's Relationship to you (son, daughter, etc.)?
How many months did Dependent #4 live with you in 2023? (If all year, enter 12)
Dependent #5's First Name
First Name
Dependent #5's Last Name
Last Name
Dependent #5's Date of Birth
01/01/2001
Dependent #5's SSN
Example: xxx-xx-xxxx
What is Dependent #5's Relationship to you (son, daughter, etc.)?
How many months did Dependent #5 live with you in 2023? (If all year, enter 12)
Are there any dependents in daycare? If yes, please upload the form you received from your daycare provider.
Yes
No
Upload a copy of your daycare form here.
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How would you like to receive your tax refund?
Check (Only available for in office visits)
Direct Deposit
Name of Bank
Which type of account would you like your refund deposited into?
Checking Account
Savings Account
Other
Routing Number
Bank Account Number
Can someone else claim you as a dependent?
Yes
No
Did you have health insurance in 2023?
Yes
No
Did you have health insurance for the entire year?
Yes
No
Who was your insurance cover through in 2023?
Please Select
The Market Place
Employer
Medicaid
Was your insurance through your employer?
Yes
No
Was your insurance through Medicaid?
Yes
No
Was your insurance through the Affordable Care Act (The Marketplace)?
Yes
No
Did your dependents have health insurance for the entire year?
Yes
No
Not Appliable
Was YOUR DEPENDENTS' insurance through your employer?
Yes
No
Not Applicable
Who was your Dependents insured with in 2023?
Please Select
Employer
Market Place
Medicaid
Upload Taxpayer & Dependent(s)Insurance Documents
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Was YOUR DEPENDENTS' insurance through Medicaid?
Yes
No
Not Applicable
Was YOUR DEPENDENTS' insurance through the Affordable Care Act (The Marketplace)?
Yes
No
Not Applicable
Have you ever been denied the Earned Tax Credit (EITC)?
Yes
No
Were you or any of your dependents in college in 2023?
Yes
No
Did you trade any Virtual Currency
Yes
No
Do you have a 1098-T Form for either you or your dependents?
Yes
No
If you have a 1098-T form, upload it here.
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Are you interested in AUDIT PROTECTION?
Yes
No
Primary Taxpayer's Signature
Date
-
Month
-
Day
Year
Date
Taxpayer's Signature (If no spouse, leave blank)
Spouse's Signature (If no spouse, leave blank)
Date
-
Month
-
Day
Year
Date
Type a question
Date
-
Month
-
Day
Year
Date
Taxpayer's Driver's License
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Taxpayer's and Dependent(s ) Social Security Card(s)
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Taxpayer's W-2/ 1099'S
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Dependent(s) Birth Certificate(s)
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Dependent(s) Proof of Residency (Lease/Utility Bill)
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Submit
Submit
Submit
Submit
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