Intake Form

COMPUTAX SERVICES, INC.

1340 TULLY RD, SUITE 314,

SAN JOSE, CA 95122

TEL. 408 286 3913

TAX CLIENT INTAKE

Disclaimer: Thank you for your interest in being a client of Computax Services Inc. This form is used to collect information about.

clients and is for internal purposes only. The information you provide is confidential and will be treated accordingly.

First name

Last name

Birthday

Month

Day

Year

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone

Occupation

Account Executive

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messages per month. Reply HELP for info, STOP to opt-out. Msg & Data rates may apply. See privacy policy at

Signature

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CompuTax