NAME:____________________________________________________________________________________
Social Security #;____________________________________________________________________________
Spouse Name:______________________________________________________________________________
Social Security:______________________________________________________________________________
Home Phone:________________________________________________________________________________
Email Add:__________________________________________________________________________________
Single _ Married _ Married Filing Jointly _ Widowed/Divorced _ Head of Household
Birth Date: Taxpayer:_________________________________________________________________________
Taxpayer's Employer:_________________________________________________________________________
Address:___________________________________________________________________________________
Spouse's Employer:__________________________________________________________________________
Address Work Phone:_________________________________________________________________________
Dependent Names
1.
Social Security #
2.
Social Security #
Social Security #
3.
This form helps to keep our files up to date. lt is your responsibility to provide all the information necessary to complete your tax returns, Blue Frog Tax Service will prepare your federal and state income tax returns from information you furnish to us with the understanding that all information is true and legal.
By your Electronic Pin Number on form 8879 and your signature below, you acknowledge your agreement to the terms set forth in the above statement. Each client is important to us ! We are pleased to have you as a client and look forward to servicing you now and for many years to come.
Read and accepted:____________________________________________________________________________
Tax Payer Signature Date:_______________________________________________________________________