Tax Client Intake Form

New Client

Existing Client

Full Name

Date of Birth

SSN / ITIN

Occupation

Home Phone

Cell Phone

Mailing Address

City

State

Zip Code

Spouse Full Name

Spouse Date of Birth

Spouse SSN / ITIN

Spouse Occupation

Student Marketplace Insurance (1095-A) Mortgage (1098) Planning to Buy House in Next 2 Years

Bank Name

Account Type

Routing Number

Account Number

I affirm that all information provided is true and correct. Signature (Full Name) Signature Date