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New Customer Registration Form
Get new customers easily using this Customer Registration Form.
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1
Client Name
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2
Did you verify phone number, mailing address, and email address in QuickBase?
YES
NO
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3
Did you verify and correct dependent listing in QuickBase?
YES
NO
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4
Did we prepare your return last year?
YES
NO
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5
How do you normally file?
Single
Married, filing jointly
Married, filing separately
Head of Household
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6
Does anyone else claim you (or your spouse) on their tax return?
YES
NO
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7
What county and state did you reside in during the last year?
Please Select
Multiple States
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Alabama - AL
Alaska - AK
Arizona - AZ
Arkansas - AR
California - CA
Colorado - CO
Connecticut - CT
Delaware - DE
Florida - FL
Georgia - GA
Hawaii - HI
Idaho - ID
Illinois - IL
Indiana - IN
Iowa - IA
Kansas - KS
Kentucky - KY
Louisiana - LA
Maine - ME
Maryland - MD
Massachusetts - MA
Michigan - MI
Minnesota - MN
Mississippi - MS
Missouri - MO
Montana - MT
Nebraska - NE
Nevada - NV
New Hampshire - NH
New Jersey - NJ
New Mexico - NM
New York - NY
North Carolina - NC
North Dakota - ND
Ohio - OH
Oklahoma - OK
Oregon - OR
Pennsylvania - PA
Rhode Island - RI
South Carolina - SC
South Dakota - SD
Tennessee - TN
Texas - TX
Utah - UT
Vermont - VT
Virginia - VA
Washington - WA
West Virginia - WV
Wisconsin - WI
Wyoming - WY
Please Select
Please Select
Multiple States
-----------------
Alabama - AL
Alaska - AK
Arizona - AZ
Arkansas - AR
California - CA
Colorado - CO
Connecticut - CT
Delaware - DE
Florida - FL
Georgia - GA
Hawaii - HI
Idaho - ID
Illinois - IL
Indiana - IN
Iowa - IA
Kansas - KS
Kentucky - KY
Louisiana - LA
Maine - ME
Maryland - MD
Massachusetts - MA
Michigan - MI
Minnesota - MN
Mississippi - MS
Missouri - MO
Montana - MT
Nebraska - NE
Nevada - NV
New Hampshire - NH
New Jersey - NJ
New Mexico - NM
New York - NY
North Carolina - NC
North Dakota - ND
Ohio - OH
Oklahoma - OK
Oregon - OR
Pennsylvania - PA
Rhode Island - RI
South Carolina - SC
South Dakota - SD
Tennessee - TN
Texas - TX
Utah - UT
Vermont - VT
Virginia - VA
Washington - WA
West Virginia - WV
Wisconsin - WI
Wyoming - WY
State
County of Residence
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8
Did your marital status change during 2019?
No Change
Got Married
Separated from Spouse
Got Divorced
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9
Date of Change
Please select the date that your marital status changed.
-
Date
Year
Month
Day
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10
Last year, did you make or receive any alimony payments?
YES
NO
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11
Please enter the total amount of alimony paid or received during 2018.
Total amount of Alimony PAID during 2018.
Total amount of Alimony RECEIVED during 2018.
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12
Did you (or your spouse) receive any Social Security or Disability payments last year?
YES
NO
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13
Did you (or your spouse) withdraw or take any distributions from a retirement account last year?
401k, IRA, ROTH, Pension, TSP, 403b, etc
YES
NO
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14
Did you (or your spouse) operate any businesses or rental properties last year?
Including direct sales businesses and AirBnB/VRBO
Please Select
Yes
No
Please Select
Please Select
Yes
No
If yes, please provide a description
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15
Did you (or your spouse) buy or sell any cyrptocurrency last year?
BitCoin, Atherium, etc
YES
NO
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16
Did you (or your spouse) sell or trade any stocks or redeem bonds last year?
YES
NO
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17
Did you (or your spouse) sell any real estate last year?
Unimproved land or houses
YES
NO
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18
Did you (or your spouse) receive any unemployment payments last year?
YES
NO
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19
Did you (or your spouse) have any cancelled credit card or loan debt forgiven last year?
Including a car repossession
YES
NO
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20
Did you (or your spouse) have any gambling winnings last year?
Including lottery, bingo, or gun bash winnings
YES
NO
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21
Did you (or your spouse) own any foreign bank accounts or have signature authority on a foreign bank account?
YES
NO
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22
Did you (or your spouse) receive any notices from the IRS or State Tax Department?
YES
NO
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23
Does anyone else in your household file a tax return?
YES
NO
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24
Have you ever received notice from the IRS stating you have been disallowed the Earned Income Tax Credit?
This would have been in the form of multiple letters from the IRS.
YES
NO
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25
Did you (or your spouse) make quarterly estimated payments last year?
If so, please make sure this information is included with your return documents.
YES
NO
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26
Were you (or your spouse) a member of the military on active duty more than 30 days last year?
YES
NO
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27
Did you (or your spouse) repay any student loans last year?
If so, please make sure that this information is included with your tax documents.
YES
NO
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28
Did you, your spouse, or any of your dependents take any type of higher education last year?
College, University, Trade or Vocational School
Myself
My Spouse
My Dependent(s)
No one took higher education last year
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29
Was each person listed on your return covered by health insurance for the full year (meaning all 12 months)?
YES
NO
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30
Did you or any person listed on your return have health insurance obtained through the Federal Marketplace?
Obamacare, healthcare.gov
YES
NO
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31
Would you like to apply for a FastCash Advance of your tax refund?
This is an advance of $500-$6000 depending on the size of your refund. You application is not a guarantee that you will qualify for the FastCash Advance. PLEASE NOTE: ADDITIONAL FEES APPLY TO APPLY FOR THE FASTCASH ADVANCE!
YES
NO
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32
Would you like to apply for a FastCash Advance of more that $2000?
FastCash Advances limited to $2000 are an interest free loan. If you would like to apply for loan amounts great than $2000, the balance will be subject to an APR of 36.0%.
YES
NO
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33
How would you like to pay for your return preparation?
**Please note that extra fees apply to withhold our prep fee from your refund!
Pay at Pickup
Prep fee withheld from refund**
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