Intake Form

CHOOSE A TAX PROS
Client Intake
Name

First NameLast Name
Social Security Number
Date Of Birth
Valid Identification & Social Security Card

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Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Utility Bill Lease Agreement (Verifying Residence)

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Email
example@example.com
Phone Number

Area CodePhone Number
Filing Status (Single Married, etc)
Occupation:
Spouse Information
Name

First NameLast Name
Social Security Number:
Date of Birth
Valid Identification & Social Security Card

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Occupation:
Did You Receive Overtime On Your Job?
W2 & Last Check Stub Upload

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ROUTING
ACCOUNT
Did you live in the United States the entire year?
If you are separated/divorced, does spouse live in the same home?
Upload Prior Year Tax Return (New Clients)

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Biological/Non-Biological Child:
Dependent Full Name
Social Security Number (Upload Card Below)
Date Of Birth
Dependent Name
Social Security Number (Upload Card Below)
Date of Birth
Dependent Name
Social Security Number (Upload Card Below)
Date of Birth
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Does the taxpayer have full custody of their dependent(s)?
How long did the child live in your home?
Explain why the dependent(s) have different last names than the taxpayer. (Father Last Name)
Can anyone else claim your dependent(s) as a dependent on their tax return?
Do you pay for child care? How much?
Do You Receive Market Place (Health Care 1095-A)
If yes upload document (1095-A) Market Place Below
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If this is not your biological child, what is your relationship to the dependent?
Did the dependent live in your home for more than 6 months?
Do you have custody?
If your dependent is over the age of 18 and Disabled, what is the nature of the disability?
Has this dependent been declared disabled by a physician?
Does dependent receive social security/disability benefits?
If so, can you provide documentation?
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Who cares for the disabled dependent while the taxpayer works?
College Credits
Which college did the student attend ?
Did student attend at least half time?
Did this student receive a tuition statement from the school?
Other Books/Materials
Did this student work while attending school?
PLEASE PROVIDE A COPY OF 1098T FORM FROM THE COLLEGE (Upload Box Below)
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SELF EMPLOYMENT DILIGENCE
Business Name (Description)
Any Employees?
# years in business
What kind of records do you keep? Check mark below
What kind of records do you Keep? Select below
Other
Business Phone

Area CodePhone Number
Business Website
Business Address
How do you advertise?
Total Business Income
If you do not have any business income, explain why
Taxpayer Signature
Preparer Notes
List Of Business Expenses (Supplies)
Total Monthly $Rent
Monthly $ Lights
Monthly $ Gas
Monthly $ Water
Car/Truck Expense
Food Consumed on the premises
Repairs and Maintenance
Insurance (Other Than Medical)
Property Taxes
Wages Paid To (Independent Contractor)
Total Expenses
Do not count money received under public assistance/welfare/foodstamps in the amount you paid. But include costs paid with public assistance in the total cost

Taxpayer has provided all answers to the above questions to be true and correct to the best of the taxpayer’s knowledge. Taxpayer has been informed that claiming a dependent for EITC/CTC?AOTC/HOH or other can result in an audit, fines and penalties if information provided to preparer is incorrect.
Upload W2's 1098-T 1099's all income Retirement HSA Gambling Child Care SSA Documents etc
File Upload

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Signature
Date
Should be Empty:

Client Intake

Biological/Non-Biological Child:

College Credits

SELF EMPLOYMENT DILIGENCE