Questionnaire Form – GLOBAL ALLIANCE SOLUTION

TAX RETURN QUESTIONNAIRE

For W2 / 1099 Clients & Others

Questions with asterisk (*) must be answered.

PART I

1. Name of Principal Tax Payer*:

2. Social Security Number*:

3. Date of Birth*:

Age

4. Address*:

City*:

State:

Zip Code:

County:

School District

5. Occupation:

6. Driving License or State ID Number*:

State:

Issued Date:

Expiration Date:

NY- ID#:

Upload you and your spouse's driving licenses, back & front:

7. Tel: Home

Work:

Mobile:

8. Fax:

Email:

9. Name of your Bank/Financial Institution:

A/C No.:

Routing No.:

The bank account where you want your refund deposited:

CheckingSavings

PART II

10. Spouse Name:

11. Social Security Number:

12. Date of Birth:

Age:

13. Occupation:

Email:

14. Driving License or State ID Number*:

State:

Issued Date:

Expiration Date:

NY-ID#

PART III

16. DEPENDENTS

Dependent 1.
Name (as it appear on your social security card):

Sex
Male Female

Relationship

DOB

Age

SSN

OccupationDid dependent live with you?
No Yes

If yes, how many months in the year?

Can anyone claim dependent or is he/she filing independently?

Is dependent disabled?

17. Filing status

PART IV

Fill in this part if you own a business or provides contractual services (1099).
(Continue to question 26 if you do not own a business or provide contractual services)

18. Name of Business

19. DBA (Doing Business As)

20. Business Address

21. Nature of Business

22. Federal EIN #

State / Local Tax ID #

23. Year Business Started

Website

24. Email

25. INCOME EXAMINER
(check any of the following items. Upload the relevant docs or summaries: W2s, 1099s, other income docs)

Wages / Salary / Tips / Contractual fees / Professional Fees, etc.Business Income (Sales / Services)Taxable Interest IncomeTaxable Ordinary DividendTaxable Refund from State & Local TaxesAlimony ReceivedBusiness Income / LossCapital Gains / LossesOther Gains / LossesIRA DistributionsPensions & AnnuitiesRental, Royalties, Partnership, S Corp., TrustFarm Income / LossesUnemployment IncomeSocial Security Benefits

26. EXPENSES EXAMINER
(Check any of the following expense items applied with total amount or upload summary of your business expenses)

Advertising

Car & Truck Expenses:

Compensation / Labor / 1099s

Depreciation

Employees’ Benefit Programs

insurance

interest-expense

legal-professional-fees

office-expense

Rent / Lease (Bus Housing / Vehicles / Machinery / Equipment)

Repairs & Maintenance

Supplies

Taxes: Withholding

Business

Property

Travel

Meal

Entertainment

Utilities

Wages

Miscellaneous

Other Expenses

Estimated Tax

PART V

27. Health Insurance: Did everyone in your household have health insurance throughout the year?
YesNo

28. Was health insurance purchased from Gov. market place

NoYes

or obtained Privately NoYes
or through Employer NoYes

29. Did you pay estimated taxes?
NoYes(if yes, upload payment voucher/s)

30. Did you pay college tuition cost?
NoYes(if yes, upload 1098-E)

31. Did you pay student loan interest?
NoYes(if yes, upload 1098-E)

32. Select any of the below items that applies to you for the tax year in review and indicate the total amount spent. For each item that applies to you, please upload supporting document/s.

Moving Expense

Educator

Alimony

State or Local Taxes

Unreimbursed Expenses

Health Saving plans

medical and dental

Home mortgage

Education Savings

Charity

Sales Taxes

Casualty and Theft

Job / Investment Cost

Miscellaneous

Adoption

Residential Energy

33. List all the states where you worked or do business and paid taxes:*:

34.Do you owe Federal/State? *: NoYes

If yes, how much do you owe?

Federal

State

By signing here below, I certify to the best of my knowledge and ability, I have answered all questions applicable to me on this form accurately and truthfully.

Name :

Date

By writing my name here, I acknowledge it represents my signature. *

Optional: Please upload digital signature here (if available)

PART VI

NOTE: If you are paying for our services from your tax refund, then you must fill out this payment authorization form using your bank debit card or credit card, for electronic withdrawal of our fees. All fields with asterisk (*) must be filled. GAS reserve the right to demand advance payment in part or in full before services are provided.

Cardholder/Bank Account Holder Name *

Address*

City *

State*

ZipCode*

Phone*

Credit Card / Debit Card Type

VisaMaster CardAMEXDiscoverOthers

Credit Card / Debit Card Number*

Expiration Date:

CCV (3 digits code )*:

Amount to Charge :

Quantity of Goods :

PAYMENT AUTHORIZATION

Please charge my credit card / debit card / bank account times for the amount indicated below

Please apply this payment to the following Order/Invoice Id

Please charge my credit or debit card or bank account Monthly in the amount of

Description of Goods or Services (Select goods or services apply)

Tax PreparationTax PlanningTax ResearchIndividual Tax AuditBusiness Tax AuditBook-Keeping AccountingBusiness Compliance (including Annual Minutes, SOX & Internal Controls)Business RegistrationManagement ConsultancyOther Business ServicesBook Sales: Dysf. OneCheaology of Chess, by JCD

I certify that I am the owner of the account indicated herein and I authorize Global Alliance Solutions, LLC (GAS) to charge the amount or amounts indicated and agreed to above for service/s rendered or for book purchases ordered.

Authorizer’s Name*

Date*

By writing my name here, I acknowledge it represents my signature. *

Optional: Please upload digital signature here (if available)