STEP 1 – CONTACT INFORMATION

Full Name *

Email *

Phone *

Preferred Method of Contact *

Call

Text

State of Residence *

STEP 2 – HOW CAN WE HELP YOU?

What do you need help with? *

Please list the tax year(s): *

STEP 3 – BASIC TAX SITUATION

Do you plan to claim dependents? *

Yes

Not sure

Number of dependents under age 17

Number of dependents ages 17–23 (full-time students)

Number of other dependents

STEP 4 – INCOME OVERVIEW

Which of the following apply to your situation?

STEP 5 – TAX STATUS & TIMING

Are you a U.S. citizen or resident for tax purposes? *

Yes

Not sure

Did you or anyone in your household have health insurance through the Marketplace (Obamacare)? *

Yes

Not sure

When do you need assistance? *

As soon as possible

Within the next 2–3 weeks

Just gathering information

STEP 6 – OPTIONAL NOTES

Anything else you’d like us to know?