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Do not enter anything in this text box otherwise your message will not be sent!
S.I.N. 234-567-890**:
Title:
Mr.
Ms.
Mrs.
Full Name**:
Date of Birth yyyy/mo/day:
Email Address**:
Telephone # 289-234-5678:
Address:
City:
Province:
Postal Code A1B 2C3:
First Time Filer:
yes
no
Status:
person with a disability
contract worker
new immigrant
full-time student
senior citizen
Marital Status:
married
single
divorced
separated
widowed
living common-law
Name of Dependant 1:
Date of Birth yyyy/mo/day:
Relationship:
son
daughter
name of Dependant 2:
Date of Birth yyyy/mo/day:
Relationship:
son
daughter
Name of Dependant 3:
Date of Birth yyyy/mo/day:
Relationship:
son
daughter
Method of Payment:
visa
amex
mastercard
email money transfer
Name of Cardholder:
Card Number:
Expiry Date yyyy/mo/day:
3 Digit # on Back of Card:
How did you hear about us?:
ad
flyers
referral
internet
newspaper
Who completed your tax return last year?:
myself via software
an accountant
HR Block/Softron/Liberty Tax
a family member/ friend
via online software
Comments:
(** Required Fields) td>