SOCIAL SECURITY NUMBER *

Date of birth *

First Name *

Last Name *

Occupation *

Phone *

HOME PHONE *

Email *

CELL PHONE COMPANY *

STATE ID OR DRIVER'S LICENSE # *

CLIENT GENDER *

ISSUE DATE *

ID EXPIRATION DATE *

STATE ID OR DRIVERS LICENSE *

Address *

City *

State *

Zip code *

Spouse Social Security Number

SPOUSE DATE OF BIRTH

SPOUSE FIRST NAME

SPOUSE OCCUPATION

SPOUSE CELL PHONE NUMBER

SPOUSE HOME PHONE

SPOUSE EMAIL ADDRESS

SPOUSE CELL PHONE COMPANY

SPOUSE ID #

SPOUSE ID STATE

SPOUSE ID TYPE

BANK NAME (required for direct deposit)

BANK ROUTING NUMBER (required for direct deposit)

BANK ACCOUNT NUMBER (required for direct deposit)

BANK ACCOUNT TYPE (required for direct deposit)

CHECKING

SAVINGS

DEPENDENT #1 NAME

DEPENDENT #1 BIRTH DATE

DEPENDENT #1 SOCIAL SECURITY NUMBER

DEPENDENT #1 RELATIONSHIP

DEPENDENT #2 NAME

DEPENDENT #2 BIRTH DATE

DEPENDENT #2 SOCIAL SECURITY NUMBER

DEPENDENT #2 RELATIONSHIP

DEPENDENT #3 NAME

DEPENDENT #3 BIRTH DATE

DEPENDENT #3 SOCIAL SECURITY NUMBER

DEPENDENT #3 RELATIONSHIP

HOW WOULD YOU LIKE TO PAY FOR YOUR TAX PREP SERVICES? *

WOULD YOU LIKE TO APPLY FOR A TAX LOAN UP TO $7,000? *

HOW WOULD YOU LIKE TO RECEIVE YOUR TAX REFUND? *

ALL INFORMATION THAT I HAVE PROVIDED TO CARTER CAPITAL ON THIS CLIENT DATA FORM IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. SIGN BELOW *

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I UNDERSTAND THAT IF MY TAX REFUND IS OFFSET FOR ANY REASON, I AM RESPONSIBLE TO REMIT PAYMENT TO CARTER CAPITAL WITHIN 30 DAYS OR MY ACCOUNT WILL BE SUBJECT TO COLLECTIONS ACTIVITIES.SIGN BELOW *

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UPLOAD VALID ID *

UPLOAD SOCIAL SECURITY CARDS

UPLOAD DEPENDENTS BIRTH CERTIFICATES

UPLOAD W2 form

DID YOU RECEIVE UNEMPLOYMENT INCOME IN 2022? PLEASE UPLOAD 1099G BELOW

1099-G UNEMPLOYMENT FORM

UPLOAD FORM 1099 NEC- CONTRACT/SELF EMPLOYED WORKERS

UPLOAD FORM 1099 NEC

DID YOU OR YOUR DEPENDENTS GOTO COLLEGE IN 2021?

UPLOAD 2021 1098T FORM

DID YOU PAY STUDENT LOAN INTEREST IN 2021?

UPLOAD FORM 1098-E FROM STUDENT LOAN PAYMENTS

DO YOU OWN A HOME?

UPLOAD 1098 FORM

DID YOU RECEIVE INTEREST INCOME?

UPLOAD FORM 1099INT

UPLOAD PROOF OF MEDICAL INSURANCE (MEDICAID CARDS, FORM 1095A, 1095B, 1095C) *

UPLOAD PROOF OF MEDICAL INSURANCE

DID YOU MAKE INVESTMENTS OR PAY CAPITAL GAINS?

UPLOAD 1099B OR 1099DIV

DID YOU START OR OPERATE A BUSINESS? PLEASE BE ADVISED YOULL HAVE TO COMPLETE MORE PAGES IF YOU REQUIRED BUSINESS TAX FILING

UPLOAD PHOTOCOPY OF EIN

What is your filing status? *

Payment is due upon submission of this form in order for your past-year tax return to be prepared. No work will begin until payment has been received and processed. Submission of this form acknowledges and agrees to this payment requirement. Fee is $425

SIGNATURE *

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