Tax Client Intake Form 2017

Tax Client's Name *

Address

Street Address

Address Line 2

City

State/Region/Province

Postal/Zip Code

Country

CLIENT INFORMATION

All fields marked with * are required and must be filled.

WELCOME!

To ensure we have the information we need to best serve you, please take a few minutes to fill out the form below. If you have any questions, please feel free to email us at [email protected] at any time. Thank you!

Taxestogo 6 digit code

Email you registered with Taxestogo

If someone referred you, please type his or her name here.

How did you hear about us?

How would you like to receive your tax refund?

If Direct Deposit, which type of account would you like your refund deposited into?

Bank Name

Routing Number

Bank Account Number

Taxpayer Name

Last Name

Taxpayers Birthdate

dd-MMM-yyyy

Taxpayer's Email

Taxpayers Phone Number

Taxpayers Social Security Number

Spouse's Name

Last Name

Spouse's Phone Number

Spouse's Job Title

Spouse's Social Security Number

Spouse's Birthdate

dd-MMM-yyyy

Spouse's Email

Address

Street Address

Address Line 2

City

State/Region/Province

Postal/Zip Code

PREFERRED CONTACT METHOD

Filing Status

Dependent #1 Name

Last Name

Middle Name

Dependent #1 Birthdate

dd-MMM-yyyy

Dependent #1 Social Security Number

What is Dependent #1's relationship to you? (Son, daughter, parent, etc.)?

How many months did Dependent #1 live with you in 2017? (If all year, enter 12)

Dependent #2 Full Name

Last Name

Middle Name

Dependent #2 Birthdate

dd-MMM-yyyy

Dependent #2 Social Security

What is Dependent #2's relationship to you? (Son, daughter, parent, etc.)?

How many months did Dependent #2 live with you in 2017? (If all year, enter 12)

Dependent #3 Full Name

Last Name

Middle Name

Dependent #3 Birthdate

dd-MMM-yyyy

Dependent #3 Social Security

What is Dependent #3's relationship to you? (Son, daughter, parent, etc.)?

How many months did Dependent #3 live with you in 2017? (If all year, enter 12)

Dependent #4 Full Name

Last Name

Middle Name

Dependent #4 Birthdate

dd-MMM-yyyy

Dependent #4 Social Security

How many months did Dependent #4 live with you in 2017? (If all year, enter 12)

What is Dependent #4's relationship to you? (Son, daughter, parent, etc.)?

What High School did you attend?

High School Name

Did you receive unemployment?

I am giving Fresh Start Business Service LLC and/or associated affiliates permission to prepare all forms related to my tax return and I have signed all necessary forms to file my income tax return electronically. I take full responsibility for the accuracy of this client intake form and understand that Fresh Start and/or associated affiliates hold no responsibility for any misrepresentation or false claims.

UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE EXAMINED THIS TAX RETURN, ACCOMPANYING SCHEDULES AND STATEMENTS, AND TO THE BEST OF MY KNOWLEDGE THEY ARE TRUE AND CORRECT.

Signature *

Clear

Date *

Name

Last Name

Are your married?

When?

Have you ever been disallowed the EITC/ AOTC/CTC?

If so, when?

Did you live in the united states?

Address

Street Address

Address Line 2

City

State/Region/Province

Postal/Zip Code

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.