Drop off Sheet
Name _______________________ Drop off date ___________________
Best # to contact _____________ Best time to contact ________________
Can we e-mail you with questions? ______
E-mail _____________________________
Did you get a new ID this year? _____ If yes, we need a copy.
Did you move in 2019? ______If yes when ________________________
New address _________________________________________________
Occupation(s) __________________________
Do you have any foreign bank account, bit coins or crypto currency? ___________
I want my refund to be directly deposited into my bank account. ______
If yes, my bank account information is the same as last year. __________
If not (or you are a new client) direct deposit information is:
Bank Name ________________________
Routing # _________________________
Account # _________________________
Checking or Savings __________________
Did you have insurance through the Marketplace in 2019? _______
If so, we will need a copy of your 1095A form.
Any changes from last year’s taxes ___________________________________
If you are a new client, we would like you to provide a copy of last year’s taxes.
Do you have a Health Savings Account? Yes/No for Family/Taxpayer
The portion you contributed ________ Employer contributed ___________
Distributions all used for medical? Yes/No