NEW CLIENT INFORMATION/UPDATE/DROP-OFF SHEET (Download & Print)
TAXPAYER SPOUSE
Full Name: _______________________________ ____________________________________
SS# _____________________________ ____________________________________
Date of Birth: ____________________________ ____________________________________
Home Address: ____________________________________________________________________
Home Phone: ____________________________ _____________________________________
Work Phone: ____________________________ _____________________________________
Cell Phone: ____________________________ ____________________________________
(Please check which phone number is the best to reach you during reg. business hours)
E-mail Address: ___________________________ __________________________________
Other e-mail: ____________________________ _________________________________
(Please mark which e-mail we can send notices and newsletters to)
Do you want to have refund, if any, directly deposited at no fee? (Yes) (No)
Bank: ________________________ Routing# ________________ Account# ______________________
Do you want to E-file your returns (at an additional $38 fee)? (Yes) (No)
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Desired Completion Date: __________________________________
Desired method of pick-up or mailing: _________________________________________________________
I understand that my desired pickup date will be the targeted completion time and when the return is completed and ready for pickup, the office will call/e-mail me and let me know of its completion. Please do not call the office before that desired date. I certify that I have reviewed and have completed the Reminder Checklist for completion of my tax return and that it is complete.
______________________________________ __________________________________________
Burchett Financial Service Agent Client
Dropped off and signed on: _______________________ Log # _____________________________
Date
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NEW CLIENTS ONLY
Who referred you? _________________________________________________________________________
Dependent Information:
Full Name ________________________________ SS# _______________ Date of Birth _________________
1. ______________________________________________________________________ M/F
2. _____________________________________________________________________ M/F
3. _____________________________________________________________________ M/F
(Write on back of page if needed)