New Client Info Business & Personal Taxes New Client Business & Personal Already Have An Appt Set With Us? * Yes No If Yes Please Type Your Appt Date In This Format mm/dd/yy Who Referred You / How Did You Hear About Wagner Tax * Please tell us who referred your or how You heard about us. FILING STATUS Choose your filing status for the current tax year being filed. FILING STATUS (PLEASE ONLY MARK ONE): * SINGLE MARRIED FILING JOINT MARRIED FILING SEPARATE HEAD OF HOUSEHOLD QUALIFYING WIDOW(ER) The Head of Household Status is for single parents or single qualified relatives raising child dependents alone. If a divorce was not final by 12/31 of the tax year being filed, you must not have lived in the same home as the separated spouse at any time during the last 6 months of the tax year. TAXPAYER INFORMATION PRIMARY TAXPAYERS NAME * (FIRST,MIDDLE INITIAL,LAST) SOCIAL SECURITY NUMBER OCCUPATION * (current occupation. If unemployed or retired please indicate so. Date Of Birth * SPOUSE INFORMATION SPOUSES NAME (FIRST,MIDDLE INITIAL,LAST) OCCUPATION (current occupation. If unemployed or retired please indicate so. SOCIAL SECURITY NUMBER Date Of Birth CONTACT INFORMATION STREET ADDRESS * This address will be used for government correspondence and will be listed as your tax returns mailing address. CITY * STATE * ZIP CODE * HOME PHONE NUMBER If no home please list primary cell phone number PRIMARY TAXPAYERS CELL * SPOUSES CELL PRIMARY TAXPAYERS EMAIL ADDRESS * SPOUSE EMAIL ADDRESS Child & Dependent Information #1 DEPENDENT #1: NAME Full Name as it appears on Social Security Card. DATE OF BIRTH The date of birth must match what is on file under the dependents social security card. SUFFIX If the child / dependent uses a suffix such as Jr. or Sr. and it is used on thier social security card please list here. SOCIAL SECURITY NUMBER RELATIONSHIP TO TAXPAYER (Son, daughter, parent, grandchild, brother, sister, other, niece, nephew, father, mother ect.) HOW MANY MONTHS DID YOUR DEPENDENT LIVE WITH YOU THIS CALENDAR YEAR? Please type only the number of months the dependent lived with you during the year. College students under 25 going to school away from home qualify as if they were living with you all 12 months for tax dependent purposes. Child & Dependent Information #2 DEPENDENT #2: NAME Full Name as it appears on Social Security Card. DATE OF BIRTH The date of birth must match what is on file under the dependents social security card. SUFFIX If the child / dependent uses a suffix such as Jr. or Sr. and it is used on thier social security card please list here. SOCIAL SECURITY NUMBER RELATIONSHIP TO TAXPAYER (Son, daughter, parent, grandchild, brother, sister, other, niece, nephew, father, mother ect.) HOW MANY MONTHS DID YOUR DEPENDENT LIVE WITH YOU THIS CALENDAR YEAR? Please type only the number of months the dependent lived with you during the year. College students under 25 going to school away from home qualify as if they were living with you all 12 months for tax dependent purposes. Child & Dependent Information #3 DEPENDENT #3: NAME Full Name as it appears on Social Security Card. DATE OF BIRTH The date of birth must match what is on file under the dependents social security card. SUFFIX If the child / dependent uses a suffix such as Jr. or Sr. and it is used on thier social security card please list here. SOCIAL SECURITY NUMBER RELATIONSHIP TO TAXPAYER (Son, daughter, parent, grandchild, brother, sister, other, niece, nephew, father, mother ect.) HOW MANY MONTHS DID YOUR DEPENDENT LIVE WITH YOU THIS CALENDAR YEAR? Please type only the number of months the dependent lived with you during the year. College students under 25 going to school away from home qualify as if they were living with you all 12 months for tax dependent purposes. Child & Dependent Information #4 DEPENDENT #4: NAME Full Name as it appears on Social Security Card. DATE OF BIRTH The date of birth must match what is on file under the dependents social security card. SUFFIX If the child / dependent uses a suffix such as Jr. or Sr. and it is used on thier social security card please list here. SOCIAL SECURITY NUMBER RELATIONSHIP TO TAXPAYER (Son, daughter, parent, grandchild, brother, sister, other, niece, nephew, father, mother ect.) HOW MANY MONTHS DID YOUR DEPENDENT LIVE WITH YOU THIS CALENDAR YEAR? Please type only the number of months the dependent lived with you during the year. College students under 25 going to school away from home qualify as if they were living with you all 12 months for tax dependent purposes. E-FILE TAX REFUND | DIRECT DEPOSIT BANKING INFORMATION. Direct Deposit of your tax refund is the safest and most secure way of receiving your refund. If you end up with a refund and would like the funds automatically deposited into your account please provide your banks routing information here. All direct deposits are initialized and handled by the US Treasury. NAME OF BANK BANK ROUTING NUMBER This is your Banks 9 digit routing number. This number can be found at the bottom of one of your checks and is exactly 9 digits. DO NOT use any number off of a deposit slip as deposit slip routing numbers are not the same. If you are unsure what your ABA or Routing number is call your bank and ask. CHECKING OR SAVINGS ACCOUNT NUMBER Please list your bank account number. Any US checking, Savings, or Financial account that can receive a direct deposit can be used. Account Type * Checking Savings BUSINESS INFO Current Name Of Your Business * Independent Contractors that do not have a business name or dba type your name. Official Business Email * Business Cell Phone * Federal ID Number (EIN) or SSN If your business has an IRS Federal ID number. please Enter it here. If you don't have one and are currently using your SSN enter that. (Main) Owner/Partner Name * Type the name of the main owner/partner of this business Percentage Of Ownership * If you are 100% owner please enter that. What Type Of Business Do You Have? * Independent Sole Proprietor Partnership LLC Corporation Enter Each Additional Owner/Partner Name & SSN (If Available) Do All Of Your Business Clients 1099 Your Business? * Yes No Some Do Not. (I Will Provide Total Income To Preparer) Choose The Type Of Income & Expense Report You Will Provide * P & L (Profit & Loss Statement Form Bookkeeper) My Own Report With Income & Totaled Expenses I'm Not Sure What To Bring (New To Business Taxes) Does Your Business Have A Different Address? (If so enter here) Does Your Business Have A Different Address? (If so enter here) Does Your Business Have A Different Address? (If so enter here) Does Your Business Have A Different Address? (If so enter here) City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Business Description & Purpose. * Briefly Summarize what your company does, its purpose, and what makes it unique Upon Submission You Will Be Redirected To Our Upload Page To Securely Upload Your Tax Docs To Us. If you are human, leave this field blank. © Wagner Tax & Accounting.
