MTS INFORMATION SHEET

CUSTOMER INFORMATION

REFERRED BY:
SOCIAL SECURITY DATE OF BIRTH
NAME OCCUPATION
CELLULAR NUMBER CELLULAR PROVIDER
EMAIL HEALTH INSURANCE COVERAGE
YESNO
SPOUSE NAME SPOUSE EMAIL
SPOUSE SOCIAL SECURITY SPOUSE DOB
STREET ADDRESS CITY
STATE ZIP
RANKING INFORMATION
ROUTING ACCOUNT NO.
CHOOSE ONE:
CHECKING ACCOUNTSAVING ACCOUNT
FILING STATUS (choose which applies):
SingleMarried Filing SeparatelyMarried Filing JointlyHead of HouseholdQualifying window(er) with dependentSelf employed
DEPENDENT INFORMATION
First Name
Last Name
SOC SEC#
Relationship
Can you or your dependents be claimed as a depender on another return?
YESNO
Do you have any outstanding debts (child support, IRS, Banks, Santa Barbara):
YESNO
I attest that all the above information is correct and was provided voluntary. In additional, none of the above information was by any fashion, shape, or form aided by of Magic Tax Solution (MTS) prepares. Therefore, I agree to release Magic Tax Solution (MTS) of any liability that may incur from the above information.