Individual Client Information Sheet
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1Individual Client Information Sheet
Personal Information
First Name
M.I.
Last Name
SSN
Date of Birth
Spouse First Name
M.I.
Spouse Last Name
SSN
Date of Birth
Mailing Address
Apt #
City
State
Zip Code
Home Phone
Fax
Work Phone
Mobile Phone
Spouse Work Phone
Spouse Mobile Phone
E-mail Address
Spouse E-mail Address
Dependent Information
Name
Date of Birth
SSN
Relationship
Months in Residence
Employment Information
Employer Name
Business name if self-employed
Occupation
Spouse Employer Name
Business name if self-employed
Spouse Occupation
Bank Information
Bank Name
Bank Account Number
Routing Number
Additional Information
Referred By:
Last year my return was prepared by:
□
□
□
□
Self
Accountant
Did not file
Other:___________________
How would you like to receive a copy of your tax return to review before it is e-filed?
□
Soft Copy: I would like to receive an encrypted copy of my return by email.
A paper copy for my records will be mailed when my return is accepted.
□
Hard Copy: I would like to receive only a paper copy of my return to review.
______By mail
_______I will pick up
I verify that the above information is correct.
Signature___________________________________________________________________
Date__________________________
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Parent category: Business