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KMR Tax and Financial Group Inc.

Tax Client Intake Form

Please complete the form below to help us prepare your tax and financial services accurately.

Client Information

Full Name:

Date of Birth:

SSN / ITIN:

Phone Number:

Email Address:

Address:

Filing Information

Filing Status:

Dependents (Name / DOB / SSN):

Employment & Income

Employment Status:
W-2 Employment
Self-Employed
Business Owner

Employer / Business Name:

Income Sources:
W-2
1099
Business Income
Rental Income
Retirement Income
Unemployment
Other

Business Information (If Applicable)

Business Name:

EIN:

Business Type:

Estimated Monthly Income:

Business Expenses

Rent
Utilities
Supplies
Vehicle
Payroll
Advertising
Insurance
Other

Services Requested

Tax Preparation
Bookkeeping
Payroll
Business Formation
Consulting

Additional Information

Please provide any additional notes or questions:

Consent

I certify that the information provided is accurate to the best of my knowledge. I understand that additional documents may be required to complete tax preparation and related services.

Client Signature:

Date:

2398 Lenora Church Road Suite 200

Phone: (404) 618-5127 | Email: [email protected]