Taxpayer Profile Questionnaire
 
Are you a previous customer:
 Yes
No
How did you hear about our company:
Taxpayer's Name:
Social Security Number:
Spouse's Name:
Spouse's Social Security Number:
Date of Birth:
Address:
City:
State:
Zip Code:
Home Phone Number:
Work or Cell Phone #:
Occupation:
E-mail address:
Marital Status:
 Single
Married
Separated
Divorced
Filing Status:
 Single
Head
Married
Married
Qualifying
Dependent #1 First Name:
Last Name:
Social Security #:
DOB:
Dependent #2 First Name:
Last Name:
Social Security #:
DOB:
Dependent #3 First Name:
Social Security #:
DOB:
Dependent #4 First Name:
Last Name:
Social Security #:
DOB:
Dependent #5 First Name:
Last Name:
Social Security #:
DOB:
Name of Daycare Provider:
Street Address of Daycare Provider:
City:
State:
Zip Code:
Social Security # or Tax ID # of Daycare Provider:
Did you or any of your dependent attend any classes throughout the tax year?:
If yes, describe your status:
Total amount of educational expenses paid including books:
Total annual daycare expenses paid:
Total mortgage interest paid:
Total real estate taxes paid:
Are you a member of Facebook:
 Yes
No
If so, what is your Facebook name:
Additional Comments: