Drop off SheetName _______________________ 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
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