First Name & Middle Initial *

Last Name *

Date of Birth *

Social Security #

Address

Street Address *

City *

State *

Country

ZIP code *

Phone *

Email *

Spouse First Name

Spouse Last Name

Dependent's First, M.I., Last Name

Dep. Date Of Birth (MM/DD/YY)

Dep. Social Sec. #

2nd Dependent's First, M.I. & Last Name

2nd Dep. Date of Birth (MM/DD/YY)

2nd Dep. Social Security #

** If more Dependents, please let your Preparer know

Filing Status *

Single

Head of Household

Married Filling Jointly

Married Filing Separately

Do You Currently Have A Plan To Provide FINANCIAL SECURITY For You & Your Family In The Event Of An Unexpected Loss? *

Yes

No

Do You Own Your Home? *

Yes

No

If NO, Are you interested in purchasing a new home? *

Yes

No

Do you currently have a 401k? *

Yes

No

Unsure

Would you like information about adding a ONE-TIME Credit sweep to your services? *

Yes

No

Unsure

Did you receive ANY other sources of Income outside of a W-2? (For example, self employment or a side business) *

Yes

No

If Eligible, Would You Be Interested In A SAME DAY Cash Advance For Up To $7,000? *

Yes

No

Would You Be Interested In The FREE Vacation Incentive We Offer? *

Yes

No

Our firm offers services beyond tax preparation. Participation is optional and not required. Please indicate if you would like information: *

Credit-Related Services

Protecting your Family through Life Insurance

Purchasing/Selling Real Estate

None

Tax Preparer Name *

Upload Any Document Such As

Copy Of ID

Copy Of Social Security Cards

Copy Of W2

Copy Of Any 1099

And/Or Any Documents That Are Tax-Related

TAX DOCUMENT UPLOAD

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