File Now File Now Email Address info@aplusstaxes.com Phone No (718)517-9212 FILE YOUR TAXES WITH JUST THIS FORM Client Registration Form Mobile Phone *Email Address *How did you hear about us?Social MediaFlyers / Door HangersDirect MailLearning how you found us helps to push our mission forward.Were you referred by anyone?If anyone told you about us, share with us their name so we can thank them.Personal InformationPrefixMr.Mrs.Ms.Mx.MissDr.Prof.First Name *Your first name written exactly as on your ID.Middle Name *Your middle name written exactly as on your ID.Last Name *Your last name written exactly as on your ID.Date of Birth *Your date of birth.Social Security Number *Your sensitive information is protected.0 / 11State & Driver's License ID # *Your private information is kept secure.Home Phone *Street Address *Apartment, suite, etcCity *State/Province *ZIP / Postal Code *Job TitleWho is your employer?Work PhoneSpouse Information (if any)PrefixMr.Mrs.Ms.Mx.MissDr.Prof.First NameSpouse first name written exactly as on the ID.Middle NameSpouse middle name written exactly as on the ID.Last NameSpouse last name written exactly as on the ID.Date of BirthSpouse date of birth.Social Security NumberYour sensitive information is protected.0 / 11State & Driver's License ID #Your private information is kept secure.Tax InformationYour filing status? *Please selectSingleMarried Filing JointMarried Filing SeparateHead of HouseholdQualifying Widow / WidowerResident StateList the state you lived in during the tax year.Non-Residence StateList any state where you had taxes withheld, but were not a resident.Did you live at your above listed address for 6 months or more this year? *Please selectYesNoDid you file your taxes last year? *Please selectYesNoIf yes, did you receive a refund? *Please selectYesNoHow did you file your taxes last year? *W-21099BusinessCheck all that apply.Can you get a copy of your prior year's return if needed? *Please selectYesNoDo you need to file form 8862? *Please selectYesNo(Stating that you were disallowed Earned Income Credit previously?)Did you have health insurance during the tax year? *Please selectYesNoDid your dependents have health insurance through your employer, state, or obamacare? *Please selectYesNoIf yes, which dependents?Dependent #1Dependent #2Dependent #3All DependentsDependent information can be given in the next section.Dependent #1First NameDependent #1 first name.Last NameDependent #1 last name.Date of BirthDependent #1 date of birth.Social Security NumberDependent #1 social security number.0 / 11Relationship To YouPlease selectSonDaughterStep ChildEligible Foster ChildBrotherSisterHalf BrotherHalf SisterStep BrotherStep SisterAdopted ChildMotherFatherGrandmotherGrandfatherQualified RelativeTo be considered a qualified dependent, you must have provided more than half of their living expenses. The child can be your son, daughter, stepchild, eligible foster child, brother, sister, half brother, half sister, stepbrother, stepsister, adopted child, mother, father, grandma, grandpa, or an offspring of any of them.Dependent #2First NameDependent #2 first name.Last NameDependent #2 last name.Date of BirthDependent #2 date of birth.Social Security NumberDependent #2 social security number.0 / 11Relationship To YouPlease selectSonDaughterStep ChildEligible Foster ChildBrotherSisterHalf BrotherHalf SisterStep BrotherStep SisterAdopted ChildMotherFatherGrandmotherGrandfatherQualified RelativeTo be considered a qualified dependent, you must have provided more than half of their living expenses. The child can be your son, daughter, stepchild, eligible foster child, brother, sister, half brother, half sister, stepbrother, stepsister, adopted child, mother, father, grandma, grandpa, or an offspring of any of them.Dependent #3First NameDependent #3 first name.Last NameDependent #3 last name.Date of BirthDependent #3 date of birth.Social Security NumberDependent #3 social security number.0 / 11Relationship To YouPlease selectSonDaughterStep ChildEligible Foster ChildBrotherSisterHalf BrotherHalf SisterStep BrotherStep SisterAdopted ChildMotherFatherGrandmotherGrandfatherQualified RelativeTo be considered a qualified dependent, you must have provided more than half of their living expenses. The child can be your son, daughter, stepchild, eligible foster child, brother, sister, half brother, half sister, stepbrother, stepsister, adopted child, mother, father, grandma, grandpa, or an offspring of any of them.Dependent Tax InformationDid all of your dependents live with you for at least 6 months? *Please selectYesNoDid you file these same dependents last year? *Please selectYesNoWill any of your dependents be filed with someone else? *Please selectYesNoDid you pay for child care for any of your dependents? *Please selectYesNoChild Care Provider (if any)First NameChild care provider first name.Last NameChild care provider last name.Street AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeChild Care Provider SS / Tax ID NumberYou can request your child care provider to give you an end of the year receipt with the total of all your payments made and her Tax ID Number.Total Amount You PaidAdditional Tax InformationHow many jobs did you work this year? *Please select123 or moreDid you receive unemployment income? *Please selectYesNoDid you attend college, night school, internet schooling, or any post-secondary educational facility to gain a skill or degree? *Please selectYesNoDo you have a 1098-T from your school? *Please selectYesNoAre you currently paying or owe student loans? *Please selectYesNoDo you own your home? *Please selectYesNoDo you owe for home buyers credit? *Please selectYesNoDo you lease out any of the property you own? *Please selectYesNoDid you pay church tithes or other charity donations? *Please selectYesNoCharity donations like or a car or any other large contributions can be tax deductible.Do you owe any student loans? *Please selectYesNoDo you owe back-payments for child support? *Please selectYesNoDo you owe the IRS? *Please selectYesNoUpload All DocumentsFinancial Documents *Drag and Drop (or) Choose FilesUpdate any and all of your identification and financial documents that are needed in order to file your taxes. Please review with our tax preparer to determine exactly what you need.Tax Refund Pay-OutHow would you like your IRS and State Tax Refund Check issued? *Please selectCheck By MailDirect DepositBank Account Number *Input your checking account number so you can receive your funds.Bank Routing Number *Input your bank routing number so you can receive your funds.BY CLICKING THE CHECKBOX BELOW, YOU HEREBY AGREE THAT THE FOREGOING INFORMATION IS TRUE AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE AND RECOLLECTION. YOU ALSO AGREE THAT YOU HOLD NO BEARINGS UPON PREPARERS OR COMPANY STAFF. YOU ALSO AGREE TO THE TERMS AND CONDITIONS OF SERVICES SET FORTH BY JUMPING JACK TAXES. *I AGREE TO THE TERMS AND CONDITIONS SET FORTH BY JUMPING JACK TAXESBY CLICKING THE CHECKBOX BELOW AND FILLING OUT MY FULL NAME AND DATE BELOW, I AM PROVIDING MY WRITTEN CONSENT AND SIGNATURE AUTHORIZATION THAT I HEREBY AGREE THAT MY ELECTRONIC SIGNATURE HOLDS VALID IN THE COURT OF LAW AND AGREE TO ALL THE TERMS AND CONDITIONS SET FORTH. *I CONSENT THAT MY WRITTEN NAME AND ELECTRONIC SIGNATURE IS TRULY SIGNED BY ME, THE SIGNATORY, AND THAT MY SIGNATURE HOLDS LEGAL AND VALID FOR ANY APPLICABLE COURTS.First NameLast NameSignatureStart signing your signature hereYour browser does not support e-Signature field.File Now!