CLIENT QUESTIONNAIRE – Collins Financial Services

New Client

Taxpayer Name *

Occupation *

Social Security Number *

Date of Birth *

E-Mail *

Telephone *

Spouse

Occupation

Social Security Number

Date of Birth

E-mail (must be separate e-mail)

Telephone

Street Address *

City *

State *

Zip Code *

If submitting information for a Business, Corporation, Trust, or Estate enter the Responsible Party information above, and enter Entity information below:

Entity Name

Entity EIN

Entity Type

Dependent 1 Name

Date of Birth

Social Security Number

Relationship

Dependent 2 Name

Date of Birth

Social Security Number

Relationship

Dependent 3 Name

Date of Birth

Social Security Number

Relationship

Dependent 4 Name

Date of Birth

Social Security Number

Relationship

Dependent 5 Name

Date of Birth

Social Security Number

Relationship

March 2021 IRS Stimulus $ *

2021 Advance Child Tax Credit $ *

Method of Payment (Must Choose One) *

Submission of this Client Questionnaire acknowledges you are requesting CFS prepare your tax returns using information provided by you. You also acknowledge tax preparation fees for services provided are due regardless of your tax refund/(debt) status.

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