Client Information Form printable pdf download

Elite

Tax & Financial Services, LLC

1241 S. Main St. Suite 17

Wake Forest, NC 27587

919-554-9400

Tax year ______

CLIENT INFORMATION FORM

Personal Contact Information

Taxpayer’s Name: _______________________________ Spouse: _______________________________

Your Occupation: _____________________________

Spouse Occupation: _______________________

Your SS# ________-______-__________

Spouse SS# _________-_______-____________

Your Date of Birth: ______/______/______

Spouse Date of Birth: ______/______/______

When E-filing you need a 5 digit pin, we can use the last 5 of your social security number or you pick your own

5 digit pin:

Taxpayer's 5 digit pin ________________

Spouse's 5 digit pin ________________

Address Information (Existing Clients - only if changed)

Address: Street: _____________________________________________________________

City: _____________________________ State: _________ Zip: _____________

Cell Phone: (______) ________________

Spouse Cell Phone: (______) ________________

Home phone (if applicable) _______________________________

Your E-mail:________________________________ Spouse E-mail:_________________________________

Primary contact person for tax-related matters? ____________________________________

Filing Status: Single____ Head of Household____ Married/Joint____ Married/Separate____

Dependent Information (Existing Clients - only if changed)

1. Full Name: ______________________________ 3. Full Name: ______________________________

Date of Birth: _______/_______/_________

SS#: _______-______-__________

2. Full Name: ______________________________4. Full Name: ______________________________

Date of Birth: _______/_______/_________

SS#: _______-______-___________

How did you hear about us? _____________________________________________________________

Referred by: __________________________________________________________________________

If you would like direct deposit, please list the Name of Bank _______________________________

Routing # _________________________

Account # _________________________

Client Information Form