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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 Information
Taxpayer*
SS#*
Birthday*
MM slash DD slash YYYY
Spouse*
SS#*
Birthday*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City 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 Name Birthdate SS# Relationship to Taxpayer Months 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

Call: 479.478.9166

Text: 479.462.4948

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Client Questionnaire

Required Information

Interest Income:

Dividend Income:

Full Name	Birthdate	SS#	Relationship to Taxpayer	Months in Home