Individual Information Form Primary Taxpayer Name* First Last Primary Taxpayer Date of Birth* MM slash DD slash YYYY Primary Taxpayer SSN Primary Taxpayer Occupation* Primary Taxpayer Mailing Address* Street Address City State / Province / Region ZIP / Postal Code Phone #1*Phone #2HiddenWork PhonePrimary Taxpayer Email* Spousal Information Check this box if you have a spouse. Spouse's Name* First Last Spouse's Date of Birth* MM slash DD slash YYYY Spouse's SSN Spouse's Occupation Spouse's Email* What brings you to us?*TaxesBookkeepingFinancial AdviceIRS CorrespondencePayrollOtherOther: How did you hear about us?* Word of Mouth Facebook Website Other Who can we thank for your referral? Dependents If you're meeting for tax purposes, check this box if you are claiming dependents. How many dependents are you claiming?Please enter a number from 1 to 4.First Dependent's Name* First Last First Dependent's Date of Birth* MM slash DD slash YYYY First Dependent's SSN Second Dependent's Name* First Last Second Dependent's Date of Birth* MM slash DD slash YYYY Second Dependent's SSN Third Dependent's Name* First Last Third Dependent's Date of Birth* MM slash DD slash YYYY Third Dependent's SSN Fourth Dependent's Name* First Last Fourth Dependent's Date of Birth* MM slash DD slash YYYY Fourth Dependent's SSN
