Client Portal SECURE CLIENT PORTAL APPLICATION 01 PERSONAL INFORMATION First Name Middle Name Last Name Date of Birth Email Address Phone Number Social Security # Occupation Home Address 02 FILLING STATUS & DEPENDENTS What is your filling status for taxes? SelectSingleHead of HouseholdMarried Filing JointlyMarried Filling SeparateQualifying Widow(er) with Dependent Spouse Information First Name Middle Name Last Name Date of Birth Email Address Phone Number Social Security # Occupation Will you be claiming children or dependents? Yes No Did the dependent live with you for more than 6 months? Yes No Do you pay for childcare? If so, please upload proof of childcare Yes No Do you own or pay a mortgage? Yes No Did you attend college this tax year? Yes No Did you purchase health insurance through the health marketplace? If so, please upload Form 1095-A SelectYesNo Will you be claiming any dependents? SelectYesNo Dependent Information Full Name SSN/ITIN DOB Relationship -+ Did the Dependent live with you for more than 6 months? SelectYesNo 03 DIRECT DEPOSIT INFORMATION Bank Name Routing Number Account Number Checking Account or Savings Account 04 PREFERRED CONTACT INFORMATION What is the best way to reach you? Selectmailemailphonetext Did someone refer you? Please provide the name 05 UPLOAD DOCUMENTS W2, 1099’s, Mortgage Interest Statement, Prior Tax Return, Proof of ID (Front/ Back) Upload files (max file is 5) (5MB limit) (jpg,png,gif,jpeg, pdf, docx) Are you interested in using the back product for your tax preparation fees? SelectYesNo Please leave this field empty. popadminClient Portal form05.04.2022
