One Stop Taxes NE Region LLC Client Intake Form

First Name:

Middle Name:

Last Name:

Referred By:

Social Security #:

Date of Birth:

Driver's License State Code:

Driver's License Issue Date:

Driver's License Expiration Date

Address Line 1:

Address Line 2:

City:

State Code:

Zip Code:

Cell Phone #:

Landline Phone #:

Is it OK to text your cell phone?

Is it OK to leave a voice message on your cell phone?

Is it OK to leave a voice message on your landline phone?

Email Address:

What is the beat day(s) and time(s) to call you?

Are you self-employed?

Do you own a business?

Do you have any prior years taxes that have not been filed?

Do you have any unresolved IRS letters, notices, or issues?

Upload your scanned tax documents (W-2', 1099's, Interest Statements, IRS Notices and Letters,etc)

Message: