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THE PMR CODE
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Intake Form
First name
(Required)
Last name
(Required)
Date Of Birth
(Required)
Phone
(Required)
Address
(Required)
SSN
(Required)
Email
(Required)
Have you filed with me before?
(Required)
Did you file taxes last year (2023)?
(Required)
Did you go to school during 2024?
(Required)
Filing Status
(Required)
Do you have Dependents ? If So how many ?
Income
(Required)
Dependent 1 information
Dependent 2 information
Dependent 3 information
Identity Pin
W2/1099/ OR any income forms?
(Required)
2023 A.G.I
Bank Information
Bank Account Number
Routing Number
Debit Card Information
Name on Card
Card Number
CVV
Exp Date
Zip code
W2/ Income
Upload File
License/ID
(Required)
Upload File
Submit
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