Smartaxx

Customer Details:

Smartaxx Attestation Form
Thank you for Choosing Smartaxx! We have a total of 26 years of experience and we are excited to offer you great customer service. Please complete the form below.
Full Name *

First Name Last Name
Occupation and DOB *

Occupation Date of Birth
Address (one person can file head of household at an address) (more than one can file single) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
Secondary Phone Number *

Area Code Phone Number
E-mail
How did you hear about us? *
Other *
File Status: Married filing Joint, Single, Head of House Hold
Do you owe any debt that could possibly affect your refund? If so, Explain

Please list Dependents

First Name

Middle name

Last name

Date of Birth

Relationship

Dependent 1

Dependent 2

Dependent 3

Dependent 4

License or ID

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Social Security Card

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Social Security Cards for Dependents

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Cancel of
W2 info or 1099 contractor

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Cancel of
Mortgage info

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Student 1098t

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Cancel of
Utility Bill

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Receipts, Tag info, Medical info, extra

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Birth Certificates for Dependents

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Please give us two people you want to refer to gain up to $100

First Name

Contact Number

1

2

Routing and Account Number

Bank info below

Account #

Routing #

Will you be willing to recommend us?

Yes Maybe No
Federal law requires this consent form be provided to you. Unless authorized by law, we cannot use, without your consent, your tax return information for purposes other than the preparation and filing of your tax return. If you consent to the use of your tax return information, Federal law
may not protect your tax return information from further use or distribution.
You are not required to complete this form. If we obtain your signature on this form by conditioning our services on your consent, your consent will not be valid. If you agree to the disclosure of your tax return information, your consent is valid for the amount of time that you
specify. If you do not specify the duration of your consent, your consent is valid for one year.
Duration of consent: Calendar year 201 through Calendar year 20
Pursuant to I (we), ___________________________________________
authorize to use any and all tax return information,
forms, schedules, documents and attachments for the purpose of offering a tax audit
assistance, support and representation service, provided by Audit Maintenance Pro, L.L.C.
If you believe your tax return information has been disclosed or used improperly in a manner
unauthorized by law or without your permission, you may contact the Treasury Inspector
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