New Taxpayer Questionnaire

As a new client, I need your help by providing the information requested below.

What is your filing status?
Social Security Number:*
Date of Birth:*
Were you self-employed?*
Did you work in any state besides your state of residency?*

If you wish to have any refunds direct deposited, please enter the bank information here:

Bank Name:
Bank Routing Number:
Bank Account Number:
Account Type:
Spouse Social Security Number:
Spouse Name:
Spouse Date of Birth:
Spouse Occupation:
Spouse Phone:
Spouse E-mail:

If you have dependents, please provide their information below.

Dependent Name:
Dependent Social Security Number:
Dependent Relationship:
Dependent Date of Birth:
Dependent Name 2:
Dependent Social Security Number 2:
Dependent Relationship 2:
Dependent Date of Birth 2:
Dependent Name 3:
Dependent Social Security Number 3:
Dependent Relationship 3:
Dependent Date of Birth 3:
Dependent Name 4:
Dependent Social Security Number 4:
Dependent Relationship 4:
Dependent Date of Birth 4:
Who Referred You?*
Word Verification: