Javis Tax Service Customer Information Form
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1Javis Tax Service Customer Information Form
PLEASE COMPLETE BEFORE HAVING TAXES PREPARED FOR ACCURACY
Referral Name_______________________________________________
DATE: _____________________________
? (check all that apply)
How Did You Hear About Us
Employee______________________ |
CW47 |
WFMV 95.3 |
Walk-In |
Returning Client ___________________
Billboard |
Facebook |
Twitter |
WWDM 101.3 |
KISS FM 100.1 |
Carolina Panorama |
Black Expo
Other_______________________
) ________________________________________________________________________
Email Address(s
Name________________________________SS#_______________________DOB___________________
Spouse Name__________________________SS#_______________________DOB___________________
Address_________________________________City________________State__________Zip____________
Cell Phone_________________ Home Phone_________________ Work Phone________________
Filing Status Check Only ONE:
Single
Head of Household
Married Filing Jointly
Married Filing Separately
****
Direct Deposit Info: Please provide a voided check or deposit ticket to avoid a delay in deposit
****
Banking Information: Routing#____________________________ Account#________________________
Name
SS#
DOB
RELATION
DISABLED STUDENT
1.___________________________________________________________________________________________
2.___________________________________________________________________________________________
3.___________________________________________________________________________________________
4.___________________________________________________________________________________________
I HEREBY ACKNOWLEDGE THE INFORMATION GIVEN ON THIS FORM IS TRUE AND CORRECT.THIS INFORMATION IS USED SOLELY FOR
INCOME TAX PREPARATION.THIS INFORMATION IS BEING FURNISHED TO THE INTERNAL REVENUE SERVICE AND THE STATE
.
DEPARTMENTS OF REVENUE.UNDER PENALTY OF PERJURY,I UNDERSTAND THIS DECLARATION WILL BE APART OF MY RETURN
Signature _____________________________________________________________________________
Spouse Signature_______________________________________________________________________
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