New Tax Client Information Sheet

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New Tax Client Information Sheet
Name: ____________________________________________________________________
Address: __________________________________________________________________
City: __________________ State: _____________ Zip Code: ______________________
Date of Birth: _________________________________
Phone Number: _______________________________ Text: Yes or No (circle one)
Email: ______________________________________
Social Security Number: ________________________
Dependents: Yes or No (circle one)
Dependent 1:
Name: _______________________________________________________________________
Date of Birth: ____________________ Social Security Number: ________________________
Dependent 2:
Name: _______________________________________________________________________
Date of Birth: ____________________ Social Security Number: ________________________
Dependent 3:
Name: _______________________________________________________________________
Date of Birth: ____________________ Social Security Number: ________________________
Banking Information for Direct Deposit
Bank Name: ___________________________________
Routing Number: _______________________________
Account Number: ______________________________ Account: Checking or Savings (circle one)
Identification
Driver’s License or State ID number: __________________________________ State Issued: ________
Issued date: _______________________
Expire Date: _______________________
Your information is highly confidential and will NOT be shared

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