Like us on Facebook! Client Questionnaire The following questions will help establish greater tax savings for you. Please read each question carefully and fill in where applicable. Please email if you have any questions. We sincerely appreciate you as a client. ***If you cannot keep your scheduled appointment, please call, fax or email us as quickly as possible. Required InformationTaxpayer*SS#*Birthday* Date Format: MM slash DD slash YYYY Spouse*SS#*Birthday* Date Format: MM slash DD slash YYYY Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone (Home)*Taxpayer Cell Phone*Spouse Cell Phone*Taxpayer Email* Spouse Email* Emergency Contact* First Last Phone*How did you hear about us? Loyal Client Website Facebook Referral Referred by:Other:Taxpayer Employer*Taxpayer Occupation*Taxpayer Work Phone*Spouse Employer*Spouse Occupation*Spouse Work Phone*Filing Status* Single Married Filing Joint Married Filing Separate Widow/Widower Head of Household Spouse Over 65? Taxpayer Dependents*Full NameBirthdateSS#Relationship to TaxpayerMonths in Home ***PLEASE PROVIDE ALL INFORMATION STATEMENTS RECEIVED: W-2, K-1, 1099, 1098, 5498, etc.Interest Income:Payer*$Payer*$Dividend Income:Payer*$Payer*$Do you need any other tax returns prepared? Gift Estate Child Parent
