First Name *

Last Name *

Email *

Address *

City *

State *

Date of birth *

Country *

Phone *

Postal code *

What is your annual income? *

$0 - $20,000

$20,001 - $40,000

$40,001 - $60,000

$60,001+

Employment Status *

Employed

Self-employed

Unemployed

Current Job Title (From employer NOT business):

Do you Rent or Own (Current Address): *

Rent

Own

How many years have you lived at Current Address *

Were you a U.S. citizen or resident alien all year? *

Yes

No

Did you live in more than one state? *

Yes

No

Support >50%

Yes

No

Did you receive EITC, CTC, or AOTC last year?

Yes

No

Did you receive advance CTC or stimulus?

Yes

No

Foreign bank/investment over $10,000?

Yes

No

Buy/sell/trade cryptocurrency?

Yes

No

Type:

Checking

Savings

Residency & Filing Status

Other IRS Due Diligence

Direct Deposit Information

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2501 Chatham Rd, Suite R,
Springfield, IL 62704
Phone: 219-533-6097

Email: [email protected]

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