Tax Client Intake 2025

Tax Client Information Tax Year 2025

Welcome to Accelerate Tax and Credit Solutions
CLIENT NAME   First Name   Last Name    SSN
OCCUPATION      DATE OF BIRTH   Date   AGE

SPOUSE NAME   First Name   Last Name   SSN
OCCUPATION      BIRTHDAY   Date   AGE
HOME ADDRESS   Street Address   Address Line 2   City   State   Zip

EMAIL   Email   BEST CONTACT NUMBER   Phone + Area Code
DRIVERS LICENSE OR ID# Type Here* ISSUING STATE Type Here*
ISSUE DATE Date* EXPIRATION DATE Date*
Driver's License or State ID*

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Please upload any income documents here. This will include ALL W-2, 1099, 1099G, etc.
File Upload

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Did you receive health insurance from the Marketplace?
Upload form 1095 here from the IRS. If you have not received it yet, please contact your provider for a replacement form.

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Initial Here* I AM INFORMED AND UNDERSTAND THAT ALL AMENDMENTS CARRY AN $300.00 UP-FRONT FEE BEFORE WE CAN MAKE ANY CHANGES ONCE YOUR TAXES HAVE BEEN SUBMITTED TO THE IRS. Please make sure you are submitting all applicable documents.
Please identify your tax preparer's name:
SingleMarried, Filing JointlyMarried, Filing SeparatelyHead of HouseholdQualifying Widow(er)
Year Spouse Died (If Applicable):
Dependent Information
Dependent #1
Full Name:   First Name   Last Name
SSN:
DOB:   Date
Relationship:
Months in Home:
Social Security Card

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Dependent #2
Full Name:   First Name   Last Name
SSN:
DOB:   Date
Relationship:
Months in Home:
Social Security Card

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Dependent #3
Full Name:   First Name   Last Name
SSN:
DOB:   Date
Relationship:
Months in Home:
Social Security Card

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Dependent #4
Full Name:   First Name   Last Name
SSN:
DOB:   Date
Relationship:
Months in Home:
Social Security Card

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YesNo
Child and dependent care (if you paid for child care for your dependent child/children, list childcare information below):
Provider:
SSN/EIN:
Address:   Street Address   Address Line 2   City   State   Zip
Amount: $
Declaration of Self-Employment

Attn! (Schedule C Due Diligence Form) - You may skip this section if you do not have a 1099 or Small Business
1. I am self-employed and my main profession/product is:
2. The name of my business is:
3. My Federal ID # (If applicable):
4. I started my business in . Please Initial.
5. I keep records of my business income and expenses. Please initial.
6. My gross sales/receipts for 1/1/2025 THRU 12/31/2025 are $.
Business Expenses
ADVERTISING EXPENSE $
CAR EXPENSE OR MILEAGE $
COMMISSION AND FEES $
INSURANCE $
LEGAL/PROFESSIONAL SERVICES $
OFFICE EXPENSE $
RENT-VEHICLE, MACHINERY $
RENT OTHER $
SUPPLIES $
TAXES AND LICENSES $
TRAVEL EXPENSES $
MEALS AND ENTERTAINMENT $
UTILITIES $
REPAIRS/MAINTENANCE $
EMPLOYEE WAGES PAID $
CONTRACT LABOR OR WAGES PAID $
MORTGAGE INTEREST $
PRIOR DEPRECIATION $
OTHER $
OTHER $
OTHER $
7.) DAYS ON THE ROAD (EX. TRUCK DRIVER)
8.) MY BUSINESS TOTAL EXPENSES FOR 1/1/2023 - 12/31/2023 $
Other Income
(1) TAXABLE SCHOLARSHIP $
(2) FOREIGN INCOME $
(3) HOUSEHOLD INCOME $
(4) PRISONER INCOME $
(5) ALIMONY RECEIVED $
(6) RETIREMENT $
(7) FARM INCOME $
(8) INVESTMENT INCOME $
(9) GAMBLING INCOME (CASINO/LOTTERY/BINGO) $
Deductions/Itemizations/Credits
(1) CHURCH CONTRIBUTIONS $
(2) UNIFORMS $
(3) CAR TAG $
(4) CHARITY $
(5) GAS $
(6) MEDICAL BILLS $
(7) COLLEGE TUITION $
(8) ENERGY CREDIT $
(9) UNEMPLOYMENT $
(10) SOCIAL SECURITY $
(11) BP CLAIM $
(12) OTHER $
(13) INTEREST $
(14) DIVIDENDS $
(15) MORTGAGE INTEREST $
(16) PROPERTY TAXES $
DO YOU HAVE RECEIPTS/DOCUMENTS TO PROVE THESE DEDUCTIONS/ITEMIZATIONS AND INCOME TO BE TRUE?
In 2020/2021 I have received my 1st stimulus payment? If yes, list the amount.*
In 2020/2021 I have received my 2nd stimulus payment? If yes, list the amount.*
In 2020/2021 I have received my 3rd stimulus payment? If yes, list the amount.*
Would you like to apply for a refund cash advance?*
Would you like to limit the amount you are approved for up to $1250?
Would you like to apply for the maximum refund advance possible up to $6000?
Direct Deposit Information
Routing Number*
Account Number*
From July to December 2021, I received Advance Child Tax Credit Payments for a total of:
If you or your dependents are a college students, please upload a copy of your 1098T here.

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Security Question: What is the name of your high school?*
IS THERE ANY INFORMATION NOT PROVIDED THAT YOU WOULD LIKE INCLUDED ON YOUR RETURN? USE SPACE BELOW
Do you have any outstanding debts with the IRS, US Treasury, Student Loans, Child Support, Federal or State Restitution? Answer Yes or No. If yes, please indicate and explain below.*
I understand that if my tax refund is intercepted by the IRS, the tax preparation fees are still due to the tax company. Unpaid fees will result in collection efforts and prohibit you from filing your taxes with A1 Success Group, LLC in the future. Initial Here*
BY SIGNING THIS FORM, I CONFIRM THE INFORMATION I AM PROVIDING A1 SUCCESS GROUP, LLC TO BE ACCURATE AND SUPPORTED BY NECESSARY DOCUMENTS. I HAVE RETAINED ALL DOCUMENTS, CANCELLED CHECKS AND OTHER DATA THAT FORMS THE BASIS OF INCOME AND DEDUCTIONS PERTAINING TO THIS TAX RETURN.
I DECLARE UNDER PENALTY OF PERJURY THAT ALL INFORMATION IS TRUE AND CORRECT. THIS DOCUMENT EXECUTED ON 2025.
Printed Name*

First NameLast Name
Signature*
Spouse's Name (if applicable)

First NameLast Name
Signature
I am aware that my return will be E-signed if available and I have received a copy of my return.
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Tax Client Information Tax Year 2025

Dependent Information

Declaration of Self-Employment

Business Expenses

Other Income

Deductions/Itemizations/Credits

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