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Email Address

info@aplusstaxes.com

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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 Information

Prefix

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 / 11

State & Driver's License ID # *Your private information is kept secure.

Home Phone *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Job Title

Who is your employer?

Work Phone

Spouse Information (if any)

Prefix

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 Birth

Spouse date of birth.

Social Security NumberYour sensitive information is protected.0 / 11

State & Driver's License ID #Your private information is kept secure.

Tax Information

Your filing status? *

Resident 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? *

Did you file your taxes last year? *

If yes, did you receive a refund? *

How 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? *

Do you need to file form 8862? *(Stating that you were disallowed Earned Income Credit previously?)

Did you have health insurance during the tax year? *

Did your dependents have health insurance through your employer, state, or obamacare? *

If yes, which dependents?

Dependent #1Dependent #2Dependent #3All DependentsDependent information can be given in the next section.

Dependent #1

First NameDependent #1 first name.

Last NameDependent #1 last name.

Date of Birth

Dependent #1 date of birth.

Social Security NumberDependent #1 social security number.0 / 11

Relationship To YouTo 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 #2

First NameDependent #2 first name.

Last NameDependent #2 last name.

Date of Birth

Dependent #2 date of birth.

Social Security NumberDependent #2 social security number.0 / 11

Dependent #3

First NameDependent #3 first name.

Last NameDependent #3 last name.

Date of Birth

Dependent #3 date of birth.

Social Security NumberDependent #3 social security number.0 / 11

Dependent Tax Information

Did all of your dependents live with you for at least 6 months? *

Did you file these same dependents last year? *

Will any of your dependents be filed with someone else? *

Did you pay for child care for any of your dependents? *

Child Care Provider (if any)

First NameChild care provider first name.

Last NameChild care provider last name.

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Child 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 Paid

Additional Tax Information

How many jobs did you work this year? *

Did you receive unemployment income? *

Did you attend college, night school, internet schooling, or any post-secondary educational facility to gain a skill or degree? *

Do you have a 1098-T from your school? *

Are you currently paying or owe student loans? *

Do you own your home? *

Do you owe for home buyers credit? *

Do you lease out any of the property you own? *

Did you pay church tithes or other charity donations? *Charity donations like or a car or any other large contributions can be tax deductible.

Do you owe any student loans? *

Do you owe back-payments for child support? *

Do you owe the IRS? *

Upload All Documents

Financial Documents *

Update 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-Out

How would you like your IRS and State Tax Refund Check issued? *

Bank 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 TAXES

BY 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 Name

Last Name

Signature