NEW CLIENT INTAKE FORM

Please be aware that you must provide a copy of your most recently filed tax return

Taxpayer Full Name: *

Taxpayer Date of Birth (MM-DD-YYYY): * +

Taxpayer Social Security Number: *

Filing Status: *

Single

Married Filing Jointly

Married Filing Separate

Head of Household

Spouse Full Name: *

Spouse Date of Birth (MM-DD-YYYY): * +

Spouse Social Security Number: *

Primary Address *

City *

State *

Zip Code *

Are you a resident of Florida? *

Yes.

No, I am a resident of another state.

State of Residency: *

Phone Number *

Phone Type: *

Cell Phone

Home Phone

Would you like to receive text messages related to your tax return and/or appointments? *

Yes, I would like to receive text messages.

No, I would like to opt-out of text messages.

Email Address *

Did you make estimated/quarterly payments for 2023? *

Yes, I will provide the dates and amounts.

No, I did not make any payments for 2023.

Date of Estimated Payment #1 (MM-DD-YYYY): +

Amount of Payment:

Date of Estimated Payment #2 (MM-DD-YYYY): +

Amount of Payment:

Date of Estimated Payment #3 (MM-DD-YYYY): +

Amount of Payment:

Date of Estimated Payment #4 (MM-DD-YYYY): +

Amount of Payment:

Are you claiming any dependents? *

Yes.

No.

Dependent Name: *

Dependent Date of Birth (MM-DD-YYYY): * +

Dependent Social Security Number: *

Relationship: *

Add another dependent? *

Yes.

No.

Dependent Name:

Dependent Date of Birth (MM-DD-YYYY): +

Dependent Social Security Number: *

Relationship:

Add another dependent ? *

Yes.

No.

Dependent Name:

Dependent Date of Birth (MM-DD-YYYY): +

Dependent Social Security Number: *

Relationship:

During 2023, did you: (a) receive crypto as a reward, award, or compensation or (b) sell, exchange, gift, or otherwise dispose of a digital asset? *

Yes.

No.

Do you own a business? *

Yes.

No.

Business Name: *

EIN: *

Business Description *

Business Phone Number: *

Business Type: *

Business Street Address: *

City, State, Zip: *

How would you like to receive your refund (if applicable)? *

Mailed Check

Direct Deposit (must provide voided check with your tax documents)

Apply to 2024 Tax Year

Bank Name: *

Account Number: *

Routing Number: *

Do you have a trust or estate? *

Yes.

No.

Name of Trust or Estate: *

EIN: *

Name of Trustee: *

Trustees Social Security Number: *

How would you like to receive your completed tax return? *

Printed copy for office pickup

DocuSign (requires electronic signature and download)

Mailed Copy (USPS First Class) *$12 Postage Fee Applies*

What Tax Services are you interested in?

How did you hear about us?

Referral Name:

By your signature below, you certify and agree that the information you have provided is complete and accurate to the best of your knowledge. You have the final responsibility for the tax returns prepared by our firm. Therefore, you should review them carefully before you sign the e-file authorization forms (if applicable), or before you sign and submit your income tax returns directly to the appropriate taxing authorities. *

clear

Notes

FOR OFFICE USE ONLY

Office:

Bonita Springs

Fort Myers

Drop off Date (MM-DD-YYYY): +

Assigned Preparer

Quoted Price:

Personal Tax Return	Business Tax Return	Bookkeeping
IRS Resolution	Tax Planning	Financial Planning

Walk-In	Website	Dave Ramsey
Friend/Family	Google	Other

NEW CLIENT INTAKE FORM

*Please be aware that you must provide a copy of your most recently filed tax return*

FOR OFFICE USE ONLY

Please be aware that you must provide a copy of your most recently filed tax return