Client Information Sheet printable pdf download

CLIENT INFORMATION SHEET

TAXPAYER PERSONAL INFORMATION

Taxpayer Full Name (from Social Security Card):________________________________________________

Social Security Number: __________________________ Date of Birth (MM-DD-YY):_________________

Occupation:__________________________________ Active Duty Military?: ☐ YES ☐ NO

Legally Blind?: ☐ YES ☐ NO Legally Disabled?: ☐ YES ☐ NO

Are you or can you be claimed as a dependent on someone else’s tax return?: ☐ YES ☐ NO

Did you and your dependents have Health Care Coverage in ALL 12 Months of 2015?: ☐ YES ☐ NO

Marital Status (as of December 31, 2015): ☐ Single ☐ Married ☐ Separated ☐ Widowed

SPOUSE PERSONAL INFORMATION

Spouse Full Name (from Social Security Card):__________________________________________________

Social Security Number: __________________________ Date of Birth (MM-DD-YY):_________________

Occupation:__________________________________ Active Duty Military?: ☐ YES ☐ NO

Legally Blind?: ☐ YES ☐ NO

Legally Disabled?: ☐ YES ☐ NO

Are you or can you be claimed as a dependent on someone else’s tax return?: ☐ YES ☐ NO

Did you have Health Care Coverage in ALL 12 Months of 2015?: ☐ YES ☐ NO

CONTACT INFORMATION

Street Address: ______________________________________________________ Apt.: ________________

City: _________________________________________ State: ____________ Zip: ____________________

Phone #1: _____________________________________ Phone #2: __________________________________

Email #1: ____________________________________ Email #2: ___________________________________

How did you hear about Wildcat Tax Service?: _________________________________________________

REFUND OR BALANCE DUE INFORMATION

☐ Check

☐ Direct Deposit/Withdrawal: Routing # ______________________ Acct. #________________________

☐ Withdrawal Date: ___________________

☐ Money Clip Visa Card (only available if tax preparation fees are withheld from a refund)

Client Information Sheet