Client Intake Form - Dooley & Company, LLC

Client Intake Form

Name

Phone(s)

Email

Spouse Name

Phone(s)

Email

Mailing Address

Current Address if Different from Mailing Address

Best person & best form of contact for questions

How did you hear about us?

*Only complete if we are doing your tax returns:

Taxpayer:

Date of Birth

Social Security Number

Driver’s License Number

Issue Date

Exp. Date

Occupation

Spouse:

Date of Birth

Social Security Number

Driver’s License Number

Issue Date

Exp. Date

Occupation

Dependents:

Name

Date of Birth

Social Security Number

Uploaded/brought prior year tax returns:

Yes

No

File Upload

Maximum upload size: 104.86MB

Allow multiple files to be uploaded.

**New Client Initial Consultation Fee $200.00
**$50.00 Cancellation Fee applies to all appointments not cancelled within 24 hours/no show

Client Signature: