Client Intake Form - Tax Preparation

Fill out the form below and submit for us to engage with you.

Wittsell & Associates Client Intake Form
Section 1: Personal Information

Taxpayer Information
Full Legal Name*

First NameLast Name
Social Security Number*
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse Information (If applicable)
Full Leagal Name

First NameLast Name
Social Security Number
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Occupation
Is your spouse a U.S. citizen?

YesNo
Section 2: Dependent Information
Do you have dependents?*

YesNo
If Yes, please complete:
Name

First NameLast Name
SSN
Relationship
Date of Birth

MonthDayYear
Date
Months lived with you
Name

First NameLast Name
SSN
Relationship
Date of Birth

MonthDayYear
Date
Months lived with you
Name

First NameLast Name
SSN
Relationship
Date of Birth

MonthDayYear
Date
Months lived with you
Name

First NameLast Name
SSN
Relationship
Date of Birth

MonthDayYear
Date
Months lived with you
Section 3: Bank Information (for Direct Deposit/Payment)
Bank Name*
Routing Number*
Account Number*
Destination*

CheckingSavings
Section 4: Signature & Date

I/we certify that the information provided is true and complete to the best of my/our knowledge
Client Signature*

Clear
Today's Date

MonthDayYear
Date
Spouse Signature

Clear
Today's Date

MonthDayYear
Date
Should be Empty:

Wittsell & Associates Client Intake Form