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)

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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.

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______________________________________      __________________________________________

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

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                                           (Write on back of page if needed)