New Client Questionnaire Please take a few moments and complete the form to ensure that we have accurate information in our files. Tax PayerName* SS#* DOB* MM slash DD slash YYYY Occupation* Cellular #Business #*Phone #*Fax #Email* Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Do you have a spouse?* Yes No SpouseName* SS#* DOB* MM slash DD slash YYYY Occupation* Cellular #Business #*Phone #*Fax #Email* Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Number of dependents?*01234DependentsName 1* SS# 1* DOB* MM slash DD slash YYYY Relationship* Name 2* SS# 2* DOB* MM slash DD slash YYYY Relationship* Name 3* SS# 3* DOB* MM slash DD slash YYYY Relationship* Name 4* SS# 4* DOB* MM slash DD slash YYYY Relationship* Refund direct deposited* Yes No Banking InformationName of Banking Institution* Account Type* Checking Savings Routing #* Account Number Year last tax returned filed:* Referred By: The above information is for confidential use only and will not be disclosed without written authorization from our clientsTax Payer Signature Date* MM slash DD slash YYYY Spouse Signature Date* MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged.