Client Intake Organizer

Thanks so much for choosing us for your Taxes and Small Business Needs. Please fill out the form below and submit prior to your appointment.

Phone *

Email *

Taxpayer Name *

Taxpayer DOB *

Taxpayer SSN *

Filing Status *

Spouse Name *

Spouse DOB *

Spouse SSN *

Address (Street, City, State, Zip) *

If you are a new client, can you provide a copy of your latest 2 years tax returns?

If yes, please email them to info@haynesbserv.com

Did you or your spouse draw any unemployment? *

Do you have any dependents? *

Dependent Information *

Are any dependents in college? *

If yes, please provide form 1098-T and books/supplies expenses.

Do you have any daycare expenses? *

Please provide the daycare form if applicable.

If you had Marketplace insurance, you must provide the 1095-A Form *

If issued a refund, would you like direct deposit? *

Bank Name

Routing Number

Account Number

Checking or Savings

Acknowledgement *