YOUR FINANCES ARE YOUR FUTURE

Intake Form

Tax Payer Name *

Date of birth

SS #

Spouse

Spouse Date Of Birth

Phone

Email

Address

City

State

Postal code

Country

Dependents, Date of birth, Relationship

Did you have health Insurance 12 months out of the year? *

Yes

No

If yes was it through the market place/Obamacare?

Yes

No

Upload Tax Docs *

Please upload any tax doc's needed to complete an accurate estimate.

Please select the following Options that apply

Own Rental Property/Properties

Real Estate Investor with 3 or More Properties

Business Owner/Or Own a % of a company

Would You like information on increasing your credit score this year?

Yes

No

Signature