Fill out Customer Data Form

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Customer Data Form
  • Your Information
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  • First Name*
    1
  • Middle Name*full name
    2
  • Last Name*full name
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  • Social Security Number*full name
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  • Date of Birth*
    5
  • Occupation*Occupation
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  • Address*full name
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  • Marital Status*full name
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  • Email*a valid email address
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  • Phone*Phone
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  • Did you receive the first stimulus check?
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  • Stimulus Check*check
    Yes
    No
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  • Do you have marketplace insurance( Form 1095-A required) Y or N
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  • marketplace insurance*
    Yes
    No
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  • Did you receive unemployment this year?
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  • unemployment*
    Yes
    No
    16
  • How did you hear about us?
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  • How did you hear about us?*
    Social Media
    Radio
    Referral
    Other
    18
  • Enter the name of the person who referred you*full name
    19
  • Country*select your country
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  • ID Number*ID Number
    21
  • ID Issue Date*make a booking
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  • ID Expiration Date*Id Expire
    23
  • Bank Information (For Direct Deposit Only)
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  • Name of Bank*Name of Bank
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  • Account Number*Account Number
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  • Routing Number*Routing Number
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  • Spouse Information
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  • First Name*name
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  • Middle Name*name
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  • Last Name*name
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  • Occupation*Occupation
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  • Email*a valid email address
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  • Spouse Date of Birth*make a booking
    34
  • Enter Spouse SSN*full name
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  • Dependents
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  • List dependents name, date of birth, social security number, relationship, and months lived in your home below.
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  • Dependents name, DOB, SSN, Relationship, Months lived in your home*
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  • Itemize*
    39
  • Possible Legal Deductions
    40
  • Do you have health insurance*select your country
    41
  • Do you or any of your dependents attend college?*select your country
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  • Do you pay for child care?*select your country
    43
  • Medical & Dental Expenses Paid $*
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  • Charitable Contributions:*
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  • Taxes Paid on
    46
  • Real Estate Tax*
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  • Personal Property Tax*
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  • State Income Tax*
    49
  • -
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  • Interest Paid on Home Mortgage*
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  • 1099 or Self Employed (yearly totals)
    52
  • Are you self employed*select your country
    53
  • If self employed do you receive a 1099 form*select your country
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  • Type of Business*full name
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  • Business Name*full name
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  • Business EIN number*full name
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  • Enter gross receipts for the year*full name
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  • Advertising*
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  • Repairs & Maintenance*
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  • Car & Trucking Expenses*
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  • Supplies*
    62
  • Legal & Professional Services*
    63
  • Taxes & Licenses*
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  • Office Expenses*
    65
  • Travel*
    66
  • Rent or Lease Payments*
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  • Meals*
    68
  • Utilities/Telephone*
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  • Other*
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  • Total Mileage*total mileage
    71
  • Cell Phone*cell phone
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  • Home Business (yearly totals)
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  • Do you use your home for business purposes?
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  • home business*
    Yes
    No
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  • If yes,
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  • Square feet used for business?*business ft2
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  • square feet used for home?*full name
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  • Educational Expenses (yearly totals)
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  • Student Loan Interest*
    80
  • Post-secondary, Tution & Fees*
    81
  • Files*upload files hereUpload Documents Here
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