top of page

Circle City Taxes, LLC

Client Information

Are you a New Client?*

Yes

No

First name

Last name

Birthday

Month

Day

Year

Social Security Number

Phone

Email

Did your address change?*

Yes

No

Multi-line address

Country/Region

Address

City

Zip / Postal code

Position/Job Title

Filing Status

Single

Head of Household

Married Filing Jointly

Married Filing Separately

Widowed

Unsure

Are you claiming dependents?

Yes

No

Are you claiming the same Dependents as last year?

Yes

No

First Name

Last Name

Date

Month

Day

Year

Social Security Number

First Name

Last Name

Date

Month

Day

Year

Social Security Number

First Name

Last Name

Date

Month

Day

Year

Social Security Number

Purchase Healthcare through the Marketplace?

Yes

No

Please Upload your 1095-A, if you don't have it call 800-318-2596 and they can give you the policy # and amounts over the phone

FAST CASH ADVANCE

Loans are not based on credit. They are between $500 and $7000. The bank determines the amount. It takes up to 24 to 48 hours for funds to arrive

Are you applying for Fast Cash Advance?

Yes

No

How would like to receive your loan or refund?

Direct Deposit

Check

Green Dot Money Card

Has your Banking Information changed?

Yes

No

Would you like to claim the rent credit? It is a State Deduction for rent that you paid. Provide info for the Individual, Apts, or Prop. Mgmt, that you paid.

Yes

No

Is it the same as Rent Amount the last year?

Yes

No

Did your rent amount change?

Yes

No

Monthly Rent Amount

Months residing there

Enter information for Landlord, Apartments, or Property Management

Landlord, Apartments, or Property Mgmt Name:

Multi-line address

Country/Region

Address

City

Zip / Postal code

Did you have Daycare Expenses?

Yes

No

Daycare or Provider Name

EIN or Social Security Number for provider

Weekly Amount

Enter any additional information:

W2's, 1099, 1095, 1098 and all Tax documents

ID, Birth Certificates, Social Security Cards

Lease, Utility Bill, Report Card, Doctors Stmnt, and etc.

Any additional documents

circlecitytaxes@gmail.com

2620 N Sherman Drive

Indianapolis, IN 46218

317-541-3200

bottom of page