Tax Client Intake Form

Thank you for choosing DISPA Distribution LLC for your tax filing needs! We’re excited to serve you. Please complete the intake form as thoroughly as possible. If you have any questions or need assistance, feel free to call us at +1 754-234-5337.

Tax Payer Information

First Name *

Last Name *

Phone *

Email *

Address

Home Address *

City *

State *

Country *

Postal Code *

Social Security Number *

Picture of Social Security Card (SSN) *

Picture of ID Card/License (one) *

Void Check

Tax Documents (W-2 Forms, 1095-A forms etc)

Filing Status *

Single

Head of Household (Single with Dependents)

Married Filing Joint

Married Filing Separate

Spouse Information

Spouse First Name *

Spouse Last Name *

Spouse Date Of Birth *

Spouse Phone Number *

Spouse Email *

Spouse Address *

Street Address Line 2 *

City *

State Province *

Postal / Zip Code *

Spouse Occupation *

Spouse Social Security Number *

Upload Spouse Social Security Card *

Upload Picture of ID Card/License

Are You Claiming Dependents? *

Yes

No

Information of Dependents

Name of dependant (as it appears on Social Security Card) *

Dependant Date Of Birth *

Social Security Card or ITIN of dependant person *

Relationship of the dependant to you *

Bank Information

Bank Name *

Routing Number *

Account Number *

Account Type *

Checking

Savings

Upload Any Additional Documents

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Tax Client Intake Form

Tax Payer Information

Spouse Information

Information of Dependents

Bank Information

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