Fee Estimate

Please complete the following pages for an estimate.

Name
Address
City	State Zip
Telephone:
E-Mail:
Comments

BASIC INFORMATION
Filing status	Single Married, Filing Jointly Married, Filing Separately Head of Household qualifying widow(er)
Dependents (Do not include yourself or spouse)	0 1 2 3 4 5 6
1040	1040EZ 1040A Regular (none)
1040X (Amended returns)	Yes No
Are you an employee?	Yes No
Are you Self-Employed?	Yes No
Do you have interest or dividend income?	Yes No
Do you have Capital Gains and Losses?	Yes No
Do you have Supplemental Income and Loss?	Yes No
Do you have Itemized Deductions?	Yes No
Do you have Pension or Annuity Income?	Yes No

STATE RETURNS

State Income Tax	(enter state)
State Income Tax	(enter state)